Individual
RANDALL ARDELL LIEBE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
122 N COURT ST, FAIRFIELD, IA 52556-2815
(641) 472-6694
(641) 472-5979
Mailing address
122 N COURT ST, FAIRFIELD, IA 52556-2815
(641) 472-6694
(641) 472-5979
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
01879
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0264960
—
IA
01
—
26496
BLUE CROSS BLUE SHIELD
IA
01
—
410020712
RAILROAD MEDICARE
IA
Enumeration date
01/29/2006
Last updated
07/26/2010
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