Provider Demographics
NPI:1326053125
Name:JEFFREY B. LIEBERMAN, O.D., INC.
Entity Type:Organization
Organization Name:JEFFREY B. LIEBERMAN, O.D., INC.
Other - Org Name:ADVANCED OPTOMETRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:805-379-1555
Mailing Address - Street 1:1014 S WESTLAKE BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3131
Mailing Address - Country:US
Mailing Address - Phone:805-379-1555
Mailing Address - Fax:
Practice Address - Street 1:1014 S WESTLAKE BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3131
Practice Address - Country:US
Practice Address - Phone:805-379-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 9292 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20775Medicare PIN