Provider Demographics
NPI:1811913593
Name:LIPPI, GINA M (OD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:LIPPI
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 1:107 OLIVER RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-2943
Mailing Address - Country:US
Mailing Address - Phone:860-644-3364
Mailing Address - Fax:
Practice Address - Street 1:194 BUCKLAND HILLS DR STE 1106
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8748
Practice Address - Country:US
Practice Address - Phone:860-644-3364
Practice Address - Fax:860-648-0592
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT2546152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U81532Medicare UPIN
410000982Medicare ID - Type Unspecified