Provider Demographics
NPI:1215388749
Name:LIBERMAN, JAYE ALEXANDRA (0D)
Entity Type:Individual
Prefix:
First Name:JAYE
Middle Name:ALEXANDRA
Last Name:LIBERMAN
Suffix:
Gender:F
Credentials:0D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39885 GRAND RIVER AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2150
Mailing Address - Country:US
Mailing Address - Phone:248-427-9620
Mailing Address - Fax:
Practice Address - Street 1:32925 GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-3155
Practice Address - Country:US
Practice Address - Phone:586-293-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004988152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist