MEDICARE: DAN LEBER OPTOMETRIST PLLC

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

General Provider Information

NPI Number	:	1831314194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAN LEBER OPTOMETRIST PLLC

Provider Business Mailing Address
First Line	:	12474 N 69TH AVE
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-9589
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20542 N LAKE PLEASANT RD
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-9749
Country	:	US
Telephone Number	:	623-878-9659
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DAN LEBER
Credential	:	OD
Telephone Number	:	623-878-9659

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	08/22/2020

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