Healthcare Provider Details

I. General information

NPI: 1215388749
Provider Name (Legal Business Name): JAYE ALEXANDRA LIBERMAN 0.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32925 GROESBECK HWY
FRASER MI
48026-3155
US

IV. Provider business mailing address

39885 GRAND RIVER AVE STE 200
NOVI MI
48375-2150
US

V. Phone/Fax

Practice location:
  • Phone: 586-293-8888
  • Fax:
Mailing address:
  • Phone: 248-427-9620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004988
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: