Healthcare Provider Details

I. General information

NPI: 1760730170
Provider Name (Legal Business Name): HUI YI LIU O.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5057 N DIXIE HIGHWAY
OAKLAND PARK FL
33334
US

IV. Provider business mailing address

5057 N DIXIE HIGHWAY
OAKLAND PARK FL
33334
US

V. Phone/Fax

Practice location:
  • Phone: 954-489-1042
  • Fax:
Mailing address:
  • Phone: 954-489-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4725
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: