Provider Demographics
NPI:1619427911
Name:LIEBSCHER, STEPHANIE CORINNE (OD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CORINNE
Last Name:LIEBSCHER
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 1:260 THAMES ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3916
Mailing Address - Country:US
Mailing Address - Phone:860-428-8254
Mailing Address - Fax:860-955-2816
Practice Address - Street 1:450 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:CT
Practice Address - Zip Code:06234-1823
Practice Address - Country:US
Practice Address - Phone:860-428-8254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2988152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0064197OtherCONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONERS