Provider Demographics
NPI:1104483338
Name:LIEPPMAN, BURKE (OD)
Entity type:Individual
Prefix:DR
First Name:BURKE
Middle Name:
Last Name:LIEPPMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 N ALVERNON WAY STE 204
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1825
Mailing Address - Country:US
Mailing Address - Phone:520-626-2010
Mailing Address - Fax:
Practice Address - Street 1:707 N ALVERNON WAY STE 301
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1848
Practice Address - Country:US
Practice Address - Phone:520-694-1460
Practice Address - Fax:520-694-1464
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002575152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist