Provider Demographics
NPI:1477623312
Name:DR CRAIG LIEBIG O D INC
Entity type:Organization
Organization Name:DR CRAIG LIEBIG O D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIEBIG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-566-7709
Mailing Address - Street 1:538B EMILY DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-5507
Mailing Address - Country:US
Mailing Address - Phone:304-566-7709
Mailing Address - Fax:304-566-4396
Practice Address - Street 1:538B EMILY DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-5507
Practice Address - Country:US
Practice Address - Phone:304-566-7709
Practice Address - Fax:304-566-4396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV743OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty