Individual
STEPHANIE CORINNE LIEBSCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
450 PROVIDENCE RD, BROOKLYN, CT 06234-1823
(860) 428-8254
Mailing address
260 THAMES ST, GROTON, CT 06340-3916
(860) 428-8254
(860) 955-2816
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2988
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0064197
CONTROLLED SUBSTANCE REGISTRATION FOR PRACTITIONERS
CT
Enumeration date
10/11/2016
Last updated
05/02/2023
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