Provider Demographics
NPI:1649362559
Name:LIPPARELLI, MATTHEW H (OD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:H
Last Name:LIPPARELLI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-3714
Mailing Address - Country:US
Mailing Address - Phone:775-753-5353
Mailing Address - Fax:775-753-6675
Practice Address - Street 1:462 IDAHO STREET
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3714
Practice Address - Country:US
Practice Address - Phone:775-753-5353
Practice Address - Fax:775-753-6675
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVOD265Medicare PIN
NVU17152Medicare UPIN