Healthcare Provider Details

I. General information

NPI: 1790795318
Provider Name (Legal Business Name): ALEX CORBIN LIU O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19735 COLIMA RD #4
ROWLAND HEIGHTS CA
91748-3227
US

IV. Provider business mailing address

19735 COLIMA RD #4
ROWLAND HEIGHTS CA
91748-3227
US

V. Phone/Fax

Practice location:
  • Phone: 909-468-4622
  • Fax: 909-468-4603
Mailing address:
  • Phone: 909-468-4622
  • Fax: 909-468-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12329T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: