1225016058 NPI number — DR. PERRY MELVIN LIEBERMAN OD

Table of content: DR. PERRY MELVIN LIEBERMAN OD (NPI 1225016058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225016058 NPI number — DR. PERRY MELVIN LIEBERMAN OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIEBERMAN
Provider First Name:
PERRY
Provider Middle Name:
MELVIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225016058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 N MARKET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINERVA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44657-1616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-868-5506
Provider Business Mailing Address Fax Number:
330-868-6483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 N MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINERVA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44657-1616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-868-5506
Provider Business Practice Location Address Fax Number:
330-868-6483
Provider Enumeration Date:
01/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3077T541 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 341176988 . This is a "AULTCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7912 . This is a "VSP PROVIDER NO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000128177 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 61854 . This is a "SPECTERA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000128178 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7111 . This is a "DAVIS VISION" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 86988 . This is a "AFSME" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 360378 . This is a "NVA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: E00341176988 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000128178 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3174328 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341176988-003 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 341176988026 . This is a "PROVIDER NO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 11129 . This is a "COAST TO COAST" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 6939 . This is a "VSP CANTON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7129 . This is a "DAVIS VISION" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0236784 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111837 . This is a "EYEMED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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