Individual
DR. DAVID CLARK LIEBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2585 LINEVILLE RD, GREEN BAY, WI 54313-7122
(920) 662-9450
(920) 662-1912
Mailing address
3172 ATLANTIS DR, GREEN BAY, WI 54313-7385
(920) 434-9425
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1748-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38515700
—
WI
01
—
410029527
RAILROAD MEDICARE
—
Enumeration date
10/31/2005
Last updated
12/11/2009
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