Provider Demographics
NPI:1760421259
Name:GOTTLIEB, HOWARD SAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:SAUL
Last Name:GOTTLIEB
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 1:732 KYLE LN
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-7925
Mailing Address - Country:US
Mailing Address - Phone:203-494-6628
Mailing Address - Fax:203-389-2360
Practice Address - Street 1:1201 BOSTON POST RD
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2703
Practice Address - Country:US
Practice Address - Phone:203-876-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT707152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410001175Medicare PIN
CTT23317Medicare UPIN