Provider Demographics
NPI:1962576702
Name:KIPP, CYNTHIA LEE (OD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LEE
Last Name:KIPP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2750 INDIAN RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5225
Mailing Address - Country:US
Mailing Address - Phone:772-569-9500
Mailing Address - Fax:772-569-9507
Practice Address - Street 1:2750 INDIAN RIVER BLVD
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5225
Practice Address - Country:US
Practice Address - Phone:772-569-9500
Practice Address - Fax:772-569-9507
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC002065152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19659Medicare ID - Type Unspecified