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General NPI Number Information
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NPI Number | 1710167143
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Entity Type | Organization
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Legal Business Name | LIEBLONG EYE CLINIC, PA
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 2800 W MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-2449
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Country | US
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Telephone | 479-968-2020
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Fax | 479-968-8803
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Provider Business Mailing Address
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Address Line | 2800 W MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-2449
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Country | US
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Telephone | 479-968-2020
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Fax | 479-968-8803
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CHLOE LIEBLONG
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Credential |
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Telephone | 479-968-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 2265
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License Number State | AR
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