Healthcare Provider Details

I. General information

NPI: 1386734556
Provider Name (Legal Business Name): YING LIU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 AZALEA RD
WINCHESTER MA
01890-2220
US

IV. Provider business mailing address

9 AZALEAD RD
WINCHESTER MA
01890-1113
US

V. Phone/Fax

Practice location:
  • Phone: 781-710-4670
  • Fax:
Mailing address:
  • Phone: 781-710-4670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4562
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: