Active NPI
Gina Marie Lippa, OPTICIAN
- Optician
- Brockport, NY
National Provider Identifier
1497787600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 006495-1
- Practice address
- 300 West Ave
Brockport, NY 14420-1118 - Phone
- (585) 637-3905
- Fax
- (585) 637-4990
- NPI assigned
- Jul 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optician | 156FX1800X | 006495-1 | NY | Primary |
Addresses
Primary practice location
300 West Ave
Brockport, NY 14420-1118
Mailing address
300 West Ave
Brockport, NY 14420-1118
Phone (585) 637-3905
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598707812 | Other | NY | OAK ORCHARD BROCKPORT NPI |
| 179014CT | Other | NY | PREFERRED CARE VENDOR # |
| 17209159 | Other | NY | EXCELLUS VENDOR # |
Other names 1
- Mrs. Gina Marie Davis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006495-1 | NY | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oak Orchard Community Health Center, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Eyewear Supplier
- Brockport, NY
- NPI 1558556738
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188950400000",
"number": "1497787600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 WEST AVE",
"city": "BROCKPORT",
"state": "NY",
"postal_code": "144201118",
"telephone_number": "585-637-3905",
"fax_number": "585-637-4990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 WEST AVE",
"city": "BROCKPORT",
"state": "NY",
"postal_code": "144201118",
"telephone_number": "585-637-3905",
"fax_number": "585-637-4990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIPPA",
"first_name": "GINA",
"middle_name": "MARIE",
"name_prefix": "Miss",
"credential": "OPTICIAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-07",
"last_updated": "2007-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "NY",
"license": "006495-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OAK ORCHARD BROCKPORT NPI",
"identifier": "1598707812",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CARE VENDOR #",
"identifier": "179014CT",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EXCELLUS VENDOR #",
"identifier": "17209159",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "GINA",
"last_name": "DAVIS",
"middle_name": "MARIE",
"prefix": "MRS.",
"credential": "OPTICIAN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Brockport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.