Healthcare Provider Details

I. General information

NPI: 1508116955
Provider Name (Legal Business Name): YING LIU OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 07/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 E H ST
CHULA VISTA CA
91910
US

IV. Provider business mailing address

6076 AFRICAN HOLLY TRL
SAN DIEGO CA
92130-6900
US

V. Phone/Fax

Practice location:
  • Phone: 619-205-5245
  • Fax:
Mailing address:
  • Phone: 408-596-1374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: