Provider Demographics
NPI:1528001708
Name:DRS. BARRACK & LIANE,PA
Entity Type:Organization
Organization Name:DRS. BARRACK & LIANE,PA
Other - Org Name:LIANE DOWNTOWN EYE ASSOCIATIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIANE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:904-356-9431
Mailing Address - Street 1:100 W BAY ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3838
Mailing Address - Country:US
Mailing Address - Phone:904-356-9431
Mailing Address - Fax:904-356-2969
Practice Address - Street 1:100 W BAY ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-3838
Practice Address - Country:US
Practice Address - Phone:904-356-9431
Practice Address - Fax:904-356-2969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1482152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078212200Medicaid
FL19674ZMedicare ID - Type Unspecified
FL078212200Medicaid
FLT84158Medicare UPIN