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General NPI Number Information
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NPI Number | 1952411050
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Entity Type | Organization
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Legal Business Name | GLAUCOMA CONSULTANTS OF THE BAY AREA A MED CORP
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2211 POST STREET SUITE 401
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City | SAN FRANCISCO
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State | CA
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Zip | 94115
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Country | US
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Telephone | 415-771-4020
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Fax | 415-771-4095
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Provider Business Mailing Address
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Address Line | 2211 POST STREET SUITE 401
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City | SAN FRANCISCO
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State | CA
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Zip | 94115
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Country | US
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Telephone | 415-771-4020
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Fax | 415-771-4095
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARE F LIEBERMAN
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Credential | MD
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Telephone | 415-771-4020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G78526
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G42547
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License Number State | CA
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