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General NPI Number Information
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NPI Number | 1962400952
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Entity Type | Individual
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Provider Name | GREGORY A LIEB OD
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Gender | Male
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 3115 W SWANN AVE
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City | TAMPA
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State | FL
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Zip | 33609-4617
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Country | US
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Telephone | 813-492-2020
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Fax | 813-492-2099
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Provider Business Mailing Address
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Address Line | 403 VONDERBURG DR
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City | BRANDON
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State | FL
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Zip | 33511-5501
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Country | US
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Telephone | 813-681-1122
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Fax | 813-689-1099
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPC 3354
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License Number State | FL
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