Provider Demographics
NPI:1245632504
Name:LIBERSHTEYN, YEVGENIYA (O D)
Entity type:Individual
Prefix:
First Name:YEVGENIYA
Middle Name:
Last Name:LIBERSHTEYN
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:LIBERSHTEYN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:O D
Mailing Address - Street 1:606 PREAKNESS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3687
Mailing Address - Country:US
Mailing Address - Phone:925-708-9203
Mailing Address - Fax:
Practice Address - Street 1:1650 RESPONSE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4807
Practice Address - Country:US
Practice Address - Phone:925-708-9203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT15375TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist