Provider Demographics
NPI:1629380514
Name:LIEB, MICHELLE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANN
Last Name:LIEB
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 1:8140 NORTON PKWY # 110
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6017
Mailing Address - Country:US
Mailing Address - Phone:440-255-1115
Mailing Address - Fax:440-255-1550
Practice Address - Street 1:8140 NORTON PKWY # 110
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6017
Practice Address - Country:US
Practice Address - Phone:440-255-1115
Practice Address - Fax:440-585-2044
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5959152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist