Individual
DR. JIM B LIEBLONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2800 W MAIN, RUSSELLVILLE, AR 72801
(479) 968-2020
(479) 968-8803
Mailing address
2800 W MAIN, RUSSELLVILLE, AR 72801
(479) 968-2020
(479) 968-8803
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2265
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103901722
—
AR
01
—
16617000041
QUALCHOICE
AR
Enumeration date
10/05/2005
Last updated
05/11/2011
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