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General NPI Number Information
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NPI Number | 1831314194
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Entity Type | Organization
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Legal Business Name | DAN LEBER OPTOMETRIST PLLC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20542 N LAKE PLEASANT RD
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City | PEORIA
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State | AZ
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Zip | 85382-9749
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Country | US
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Telephone | 623-878-9659
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Fax |
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Provider Business Mailing Address
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Address Line | 12474 N 69TH AVE
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City | PEORIA
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State | AZ
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Zip | 85381-9589
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DAN LEBER
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Credential | OD
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Telephone | 623-878-9659
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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 | 775
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License Number State | AZ
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