Provider Demographics
NPI:1033260203
Name:LIBERMAN, ALAN LEO (DISPENSING OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:LEO
Last Name:LIBERMAN
Suffix:
Gender:M
Credentials:DISPENSING OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14210 PALM DR
Mailing Address - Street 2:SUITE A2
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-6873
Mailing Address - Country:US
Mailing Address - Phone:760-329-0528
Mailing Address - Fax:
Practice Address - Street 1:14210 PALM DR
Practice Address - Street 2:SUITE A2
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-6873
Practice Address - Country:US
Practice Address - Phone:760-329-0528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD3425156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADX003425FMedicaid