Provider Demographics
NPI:1336250331
Name:LIEGLER, TIMOTHY SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:SCOTT
Last Name:LIEGLER
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 1:18582 MAIN ST
Mailing Address - Street 2:ATTN: LORRY DUNCAN
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1701
Mailing Address - Country:US
Mailing Address - Phone:714-965-9696
Mailing Address - Fax:714-965-9797
Practice Address - Street 1:18582 MAIN ST
Practice Address - Street 2:LORRY DUNCAN
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1701
Practice Address - Country:US
Practice Address - Phone:714-965-9696
Practice Address - Fax:714-965-9797
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT7983TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU67237Medicare UPIN
CAWOP7983EMedicare PIN