Lieburn, David Clark
Lieburn, David Clark is an individual health care provider with primary practice located at 2585 Lineville Rd , Green Bay WI 54313-7122. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Lieburn, David Clark can be contacted via phone (920) 662-9450.Contact Information
Primary practice address
2585 Lineville Rd
Green Bay WI 54313-7122
Phone: (920) 662-9450
Fax: (920) 662-1912
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1748-035 | Wisconsin |
Profile Details
| NPI number | 1740271782 |
|---|---|
| LBN Legal business name | Lieburn, David Clark |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 31st, 2005 |
| Last updated | Dec 11th, 2009 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1740271782 | NPPES |
| Wisconsin | MEDICAID | 38515700 | |
| Wisconsin | Other | 410029527 |
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