Healthcare Provider Details

I. General information

NPI: 1750351268
Provider Name (Legal Business Name): AMY LIU LYNN LONGACRE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6155 STONERIDGE DR SUITE 100
PLEASANTON CA
94588-3204
US

IV. Provider business mailing address

3591 CRESPI CT
PLEASANTON CA
94566-7561
US

V. Phone/Fax

Practice location:
  • Phone: 925-463-2150
  • Fax: 925-463-1186
Mailing address:
  • Phone: 925-463-2150
  • Fax: 925-463-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7518TPL
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: