| Doctor Name: | ALTA M LEBECK |
| NPI Number: | 1093128050 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.D.O. |
| License Number: | LDO002502 |
| Business Practice Address: | 363 Main St S Tifton, GA - 317944813 |
| Business Phone Number: | 2293824441 |
| Business Fax Number: | 2293860211 |
| Mailing Address: | 363 Main St S, TIFTON |
| State: | GA |
| Postal Code: | 317944813 |
| Phone Number: | 2293824441 |
| Fax Number: | 2293860211 |
| NPI Enumeration Date: | 06/07/2014 |
| NPI Last Update Date: | 06/07/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | LDO002502 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |