Provider Demographics
NPI:1821300336
Name:MATTHEW LIPPAS MD PA
Entity Type:Organization
Organization Name:MATTHEW LIPPAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-369-3433
Mailing Address - Street 1:8144 WALNUT HILL LN
Mailing Address - Street 2:448
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4388
Mailing Address - Country:US
Mailing Address - Phone:214-369-3433
Mailing Address - Fax:214-369-0636
Practice Address - Street 1:8144 WALNUT HILL LN
Practice Address - Street 2:448
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4388
Practice Address - Country:US
Practice Address - Phone:214-369-3433
Practice Address - Fax:214-369-0636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6740207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC18457Medicare UPIN