Provider Demographics
NPI:1952411050
Name:GLAUCOMA CONSULTANTS OF THE BAY AREA A MED CORP
Entity Type:Organization
Organization Name:GLAUCOMA CONSULTANTS OF THE BAY AREA A MED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARE
Authorized Official - Middle Name:F
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-771-4020
Mailing Address - Street 1:2211 POST STREET
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115
Mailing Address - Country:US
Mailing Address - Phone:415-771-4020
Mailing Address - Fax:415-771-4095
Practice Address - Street 1:2211 POST STREET
Practice Address - Street 2:SUITE 401
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-771-4020
Practice Address - Fax:415-771-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42547207W00000X
CAG78526207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ09878ZOtherBLUE SHIELD OF CA
CAGR0099190Medicaid
CAZZZ31449ZMedicare ID - Type Unspecified