Provider Demographics
NPI:1225016058
Name:LIEBERMAN, PERRY MELVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:MELVIN
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-1616
Mailing Address - Country:US
Mailing Address - Phone:330-868-5506
Mailing Address - Fax:330-868-6483
Practice Address - Street 1:206 N MARKET ST
Practice Address - Street 2:
Practice Address - City:MINERVA
Practice Address - State:OH
Practice Address - Zip Code:44657-1616
Practice Address - Country:US
Practice Address - Phone:330-868-5506
Practice Address - Fax:330-868-6483
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2008-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3077T541152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341176988OtherAULTCARE
OH7912OtherVSP PROVIDER NO
OH000000128177OtherANTHEM
OH61854OtherSPECTERA
OH000000128178OtherAETNA
OH7111OtherDAVIS VISION
OH86988OtherAFSME
OH360378OtherNVA
OHE00341176988OtherAETNA
OH000000128178OtherANTHEM
OH3174328OtherCIGNA
OH341176988-003OtherMEDICAL MUTUAL
OH341176988026OtherPROVIDER NO
OH11129OtherCOAST TO COAST
OH6939OtherVSP CANTON
OH7129OtherDAVIS VISION
OH0236784Medicaid
OH111837OtherEYEMED
OH1225016058Medicare NSC
OH86988OtherAFSME
OH61854OtherSPECTERA
OHT46720Medicare UPIN