Provider Demographics
NPI:1366493694
Name:GOTTLIEB, CURT ALLEN (OD)
Entity Type:Individual
Prefix:
First Name:CURT
Middle Name:ALLEN
Last Name:GOTTLIEB
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 1:212 SAXONY DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1683
Mailing Address - Country:US
Mailing Address - Phone:215-968-1910
Mailing Address - Fax:215-348-0218
Practice Address - Street 1:4391 W SWAMP RD
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18902-1039
Practice Address - Country:US
Practice Address - Phone:215-348-3127
Practice Address - Fax:215-348-0218
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T72870Medicare UPIN
PA155049Medicare ID - Type Unspecified