Provider Demographics
NPI:1801903513
Name:LIPSON, BARRY K (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:K
Last Name:LIPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16899 W BERNARDO DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1603
Mailing Address - Country:US
Mailing Address - Phone:858-521-2301
Mailing Address - Fax:858-521-2018
Practice Address - Street 1:16899 W BERNARDO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1603
Practice Address - Country:US
Practice Address - Phone:858-521-2301
Practice Address - Fax:858-521-2018
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57021207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G570210Medicaid
CAE29481Medicare UPIN
CAWG57021AMedicare ID - Type Unspecified