Healthcare Provider Details

I. General information

NPI: 1568854768
Provider Name (Legal Business Name): JEN HSIANG LIU O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19209 COLIMA RD STE C
ROWLAND HEIGHTS CA
91748-3009
US

IV. Provider business mailing address

19209 COLIMA RD STE C
ROWLAND HEIGHTS CA
91748-3009
US

V. Phone/Fax

Practice location:
  • Phone: 626-363-4991
  • Fax:
Mailing address:
  • Phone: 626-363-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number15186
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number15186
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number15186
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number15186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: