Provider Demographics
NPI:1316051865
Name:ORBECK, KIP (OD)
Entity type:Individual
Prefix:DR
First Name:KIP
Middle Name:
Last Name:ORBECK
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 1:1130 N LOOP 1604 W
Mailing Address - Street 2:STE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-4506
Mailing Address - Country:US
Mailing Address - Phone:210-545-2020
Mailing Address - Fax:210-479-7960
Practice Address - Street 1:1130 N LOOP 1604 W
Practice Address - Street 2:STE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-4506
Practice Address - Country:US
Practice Address - Phone:210-545-2020
Practice Address - Fax:210-479-7960
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU24855Medicare UPIN
TXE57T0Medicare ID - Type Unspecified