Provider Demographics
NPI:1477986289
Name:LEBRICK, MARGE LYNNE (MSED, CVRT)
Entity Type:Individual
Prefix:
First Name:MARGE
Middle Name:LYNNE
Last Name:LEBRICK
Suffix:
Gender:F
Credentials:MSED, CVRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 MIRAGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467
Mailing Address - Country:US
Mailing Address - Phone:715-342-3907
Mailing Address - Fax:
Practice Address - Street 1:3262 CHURCH ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-5321
Practice Address - Country:US
Practice Address - Phone:715-344-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5294152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy