MEDICARE: DR. DAN LEBER OD

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	775	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699745851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAN LEBER OD

Provider Business Mailing Address
First Line	:	20542 N LAKE PLEASANT RD
Second Line	:	SUITE 107
City	:	PEORIA
State	:	AZ
Zip	:	85382-9749
Country	:	US
Telephone Number	:	632-572-9090
Fax Number	:	623-572-9797

Provider Business Practice Location Address
First Line	:	20542 N LAKE PLEASANT RD
Second Line	:	SUITE 107
City	:	PEORIA
State	:	AZ
Zip	:	85382-9749
Country	:	US
Telephone Number	:	632-572-9090
Fax Number	:	623-572-9797

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	12/07/2015

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