Healthcare Provider Details

I. General information

NPI: 1205081411
Provider Name (Legal Business Name): PERRY M LIEBERMAN OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N MARKET ST
MINERVA OH
44657-1616
US

IV. Provider business mailing address

206 N MARKET ST
MINERVA OH
44657-1616
US

V. Phone/Fax

Practice location:
  • Phone: 330-868-5506
  • Fax: 330-868-6483
Mailing address:
  • Phone: 330-868-5506
  • Fax: 330-868-6483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3077
License Number StateOH

VIII. Authorized Official

Name: DR. PERRY M LIEBERMAN
Title or Position: OWNER
Credential: OD
Phone: 330-868-5506