Healthcare Provider Details

I. General information

NPI: 1346801933
Provider Name (Legal Business Name): TAMMY LIU NA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15333 CULVER DR STE 690
IRVINE CA
92604-7143
US

IV. Provider business mailing address

339 MEMORY LN
SANTA ANA CA
92705-6021
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-4271
  • Fax:
Mailing address:
  • Phone: 909-634-0867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34240TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: