LIEBLONG EYE CLINIC PA NPI 1710167143

NPI Information

LIEBLONG EYE CLINIC, PA is a customized equipment durable medical equipment medical supplies in Russellville, AR. LIEBLONG EYE CLINIC, PA NPI is 1710167143. The provider is registered as an organization entity type.

The provider's business location address is:

2800 W MAIN ST
RUSSELLVILLE, AR
ZIP 72801-449
Phone: (479) 968-2020
Fax: (479) 968-8803

The provider's authorized official is Chloe Lieblong .
The authorized official title is Office Manager and has the following contact phone number (479) 968-2020.

The CLIA number assigned to this NPI record is 04D1093968 - other - optometric physician with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/14/2007 and was last updated on 5/12/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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