MEDICARE: DR. PETER J LIBERTO O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	434T	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	22-00053	OTHER	RI	UNITEDHEALTHCARE
2	2804	OTHER	RI	NEIGHBORHOOD HEALTH
3	7848-3	OTHER	RI	BLUE CROSS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	004369	OTHER	RI	BLUE CHIP

General Provider Information

NPI Number	:	1396730453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER J LIBERTO O.D.

Provider Business Mailing Address
First Line	:	145 NEWPORT AVE
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02861-4107
Country	:	US
Telephone Number	:	401-729-0200
Fax Number	:	401-729-0222

Provider Business Practice Location Address
First Line	:	145 NEWPORT AVE
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02861-4107
Country	:	US
Telephone Number	:	401-729-0200
Fax Number	:	401-729-0222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	07/08/2007

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