Provider Demographics
NPI:1104855097
Name:LIEBER, ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:
Last Name:LIEBER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CHANA ANNE
Other - Middle Name:
Other - Last Name:LIEBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:40 W 116TH ST APT B1005
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2980
Mailing Address - Country:US
Mailing Address - Phone:917-526-1073
Mailing Address - Fax:
Practice Address - Street 1:40 W 116TH ST APT B1005
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2980
Practice Address - Country:US
Practice Address - Phone:917-526-1073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006386152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01672999Medicaid