Active NPI
Randall Ardell Liebe, O.D.
- Optometrist
- Fairfield, IA
National Provider Identifier
1699746644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 01879
- Practice address
- 122 N Court St
Fairfield, IA 52556-2815 - Phone
- (641) 472-6694
- Fax
- (641) 472-5979
- NPI assigned
- Jan 29, 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 | 01879 | IA | Primary |
Addresses
Primary practice location
122 N Court St
Fairfield, IA 52556-2815
Mailing address
122 N Court St
Fairfield, IA 52556-2815
Phone (641) 472-6694
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 410020712 | Other | IA | RAILROAD MEDICARE |
| 26496 | Other | IA | BLUE CROSS BLUE SHIELD |
| 0264960 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01879 | IA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eyeowa Optical Company | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optician
- Fairfield, IA
- NPI 1932356680
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280102400000",
"number": "1699746644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "122 N COURT ST",
"city": "FAIRFIELD",
"state": "IA",
"postal_code": "525562815",
"telephone_number": "641-472-6694",
"fax_number": "641-472-5979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "122 N COURT ST",
"city": "FAIRFIELD",
"state": "IA",
"postal_code": "525562815",
"telephone_number": "641-472-6694",
"fax_number": "641-472-5979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEBE",
"first_name": "RANDALL",
"middle_name": "ARDELL",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-29",
"last_updated": "2010-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IA",
"license": "01879",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410020712",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "26496",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0264960",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.