Provider Demographics
NPI:1750448973
Name:LIEBERMAN, HARRIS M (OD)
Entity Type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:M
Last Name:LIEBERMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 MIDVALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1027
Mailing Address - Country:US
Mailing Address - Phone:215-438-2507
Mailing Address - Fax:
Practice Address - Street 1:1017 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4213
Practice Address - Country:US
Practice Address - Phone:215-922-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET009024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist