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General NPI Number Information
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NPI Number | 1417270752
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Entity Type | Organization
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Legal Business Name | LIBERTY EYECARE, INC.
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 02/23/2020
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Provider Practice Location Address
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Address Line | 1100 E KEMPER RD
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City | SPRINGDALE
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State | OH
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Zip | 45246-3321
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Country | US
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Telephone | 513-346-7952
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Fax | 513-346-4042
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Provider Business Mailing Address
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Address Line | 5542 SCHLADE CT
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City | LIBERTY TWP
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State | OH
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Zip | 45044-9037
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Country | US
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Telephone | 513-257-6188
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Fax | 513-346-4042
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY ALLEN LIETTE
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Credential | OD
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Telephone | 513-257-6188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OH4857
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License Number State | OH
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