Provider Demographics
NPI:1285771956
Name:LIPSON, RUTH (OD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:
Last Name:LIPSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:25590 PRADO DE ORO
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302
Mailing Address - Country:US
Mailing Address - Phone:818-222-9850
Mailing Address - Fax:818-222-9850
Practice Address - Street 1:11996 VENTURA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2606
Practice Address - Country:US
Practice Address - Phone:818-763-1875
Practice Address - Fax:818-505-0165
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8913T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU76550Medicare UPIN