Individual
MARK ERNEST LIEBETREU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
6091 S POINTE BLVD, FT MYERS, FL 33919-4899
(239) 466-2020
(239) 985-7118
Mailing address
PO BOX 11407, BIRMINGHAM, AL 35246-8575
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OP0002191
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20537
BCBS
FL
01
—
20537Z
PTAN
FL
05
—
620041900
—
FL
01
—
PG040
PTAN
FL
Enumeration date
10/11/2005
Last updated
07/17/2025
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