Active NPI
Charles Edward Lieberman III, O.D.
- Optometrist
- Troy, MO
National Provider Identifier
1164537536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T03256
- Practice address
- 101 Highway 47 E
Troy, MO 63379-3100 - Phone
- (636) 528-8960
- Fax
- (636) 528-8974
- NPI assigned
- Aug 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T03256 | MO | Primary |
Addresses
Primary practice location
101 Highway 47 E
Troy, MO 63379-3100
Mailing address
23 Royallbend CT
O Fallon, MO 63368-6861
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120216000501 | MO | Practitioner - Optometry | 5092973354 | Practice locations: Troy, MO |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321401600000",
"number": "1164537536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23 ROYALLBEND CT",
"city": "O FALLON",
"state": "MO",
"postal_code": "633686861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 HIGHWAY 47 E",
"city": "TROY",
"state": "MO",
"postal_code": "633793100",
"telephone_number": "636-528-8960",
"fax_number": "636-528-8974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEBERMAN",
"first_name": "CHARLES",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-19",
"last_updated": "2011-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "T03256",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.