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General NPI Number Information
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NPI Number | 1528001708
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Entity Type | Organization
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Legal Business Name | DRS. BARRACK & LIANE,PA
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Dates
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Enumeration Date | 06/14/2006
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Last Update Date | 08/21/2009
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Provider Practice Location Address
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Address Line | 100 W BAY ST
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City | JACKSONVILLE
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State | FL
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Zip | 32202-3838
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Country | US
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Telephone | 904-356-9431
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Fax | 904-356-2969
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Provider Business Mailing Address
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Address Line | 100 W BAY ST
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City | JACKSONVILLE
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State | FL
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Zip | 32202-3838
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Country | US
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Telephone | 904-356-9431
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Fax | 904-356-2969
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PETER D. LIANE
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Credential | O.D.
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Telephone | 904-356-9431
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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 | OPC1482
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License Number State | FL
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