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:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005385152WV0400X, 152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist