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Individual

DANIEL A LIEBERMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
4418 W DIVERSEY AVE, CHICAGO, IL 60639-1924
(773) 736-6800
Mailing address
4418 W DIVERSEY AVE, CHICAGO, IL 60639-1924

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008138
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
046008138
IL
01
1636706
BCBS
01
210209
GROUP MEDICARE
01
211019
GROUP MEDICARE
01
410014597
RR MEDICARE
01
7235044
AETNA
01
K15488
MEDICARE
01
K44386
MEDICARE
Enumeration date
08/15/2006
Last updated
06/30/2014
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