Healthcare Provider Details

I. General information

NPI: 1346541901
Provider Name (Legal Business Name): CHUNMING LIU OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 E 2ND ST SUITE 2
POMONA CA
91766-2007
US

IV. Provider business mailing address

795 E 2ND ST SUITE 2
POMONA CA
91766-2007
US

V. Phone/Fax

Practice location:
  • Phone: 909-706-3899
  • Fax: 909-469-8640
Mailing address:
  • Phone: 909-469-8773
  • Fax: 909-469-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number14079TLG
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT14079TLG
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number14079TLG
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number14079TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: