MEDICARE: JOHN SIC-YIU LIU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	6498T	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00036039	OTHER		MEDICARE R/R

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114949419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN SIC-YIU LIU

Provider Business Mailing Address
First Line	:	3550 CASTRO VALLEY BLVD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-4402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 CASTRO VALLEY BLVD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-4402
Country	:	US
Telephone Number	:	510-581-1680
Fax Number	:	510-581-5070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	06/16/2009

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Directions to “ JOHN SIC-YIU LIU ” Practice Location

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