MEDICARE: DAVID LANE LEIBSTEIN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV005756-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598714321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID LANE LEIBSTEIN O.D.

Provider Business Mailing Address
First Line	:	3074 MESSICK AVE
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-2946
Country	:	US
Telephone Number	:	516-993-0452
Fax Number	:	516-536-4322

Provider Business Practice Location Address
First Line	:	532 BROADWAY
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-5004
Country	:	US
Telephone Number	:	516-798-2635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	05/14/2026

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