Provider Demographics
NPI:1821139387
Name:LIEBERMAN & LIEBERMAN OPTOMETRY, PLLC
Entity Type:Organization
Organization Name:LIEBERMAN & LIEBERMAN OPTOMETRY, PLLC
Other - Org Name:ST. PAULS VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-865-9800
Mailing Address - Street 1:327 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-1741
Mailing Address - Country:US
Mailing Address - Phone:910-865-9800
Mailing Address - Fax:
Practice Address - Street 1:327 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-1741
Practice Address - Country:US
Practice Address - Phone:910-865-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890144QMedicaid
NC0144QOtherBCBS
NC890144QMedicaid
NC1129740001Medicare NSC