Organization
LIEBLONG EYE CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHLOE LIEBLONG (OFFICE MANAGER)
(479) 968-2020
Entity
Organization
Contact information
Practice address
2800 W MAIN ST, RUSSELLVILLE, AR 72801-2449
(479) 968-2020
(479) 968-8803
Mailing address
2800 W MAIN ST, RUSSELLVILLE, AR 72801-2449
(479) 968-2020
(479) 968-8803
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
2265
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103901722
—
AR
01
—
16617000041
QUAL CHOICE
AR
01
—
410014279
RAILROAD RETIREMENT
AR
Enumeration date
11/14/2007
Last updated
05/12/2011
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