Provider Demographics
NPI:1992873269
Name:GOTTLIEB, RAYMOND LESLIE (OD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LESLIE
Last Name:GOTTLIEB
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 1:336 BERKELEY ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-3311
Mailing Address - Country:US
Mailing Address - Phone:585-461-3716
Mailing Address - Fax:585-271-6924
Practice Address - Street 1:336 BERKELEY ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-3311
Practice Address - Country:US
Practice Address - Phone:585-461-3716
Practice Address - Fax:585-271-6924
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005385152WV0400X, 152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation