Provider Demographics
NPI:1558346155
Name:LALIBERTE, RENEE LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:LYNN
Last Name:LALIBERTE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8089 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-1079
Mailing Address - Country:US
Mailing Address - Phone:734-424-9230
Mailing Address - Fax:
Practice Address - Street 1:8089 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-1079
Practice Address - Country:US
Practice Address - Phone:734-424-9230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003882152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N91220Medicare ID - Type Unspecified
MIU80025Medicare UPIN