Provider Demographics
NPI:1942269576
Name:LIPPENS, JENNIFER R (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:LIPPENS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29648-1206
Mailing Address - Country:US
Mailing Address - Phone:864-229-2301
Mailing Address - Fax:864-229-1898
Practice Address - Street 1:711 MONTAGUE AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-1440
Practice Address - Country:US
Practice Address - Phone:864-229-2301
Practice Address - Fax:864-229-1898
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1280152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD12804Medicaid
SC5200850001Medicare NSC
SCU97115Medicare UPIN
SCD12804Medicaid