Healthcare Provider Details

I. General information

NPI: 1114656972
Provider Name (Legal Business Name): JENNIFER JING LIU OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY LIU OD

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 HEALY BLVD
HUDSON NY
12534-1509
US

IV. Provider business mailing address

78 RIDGEWAY
CATSKILL NY
12414-5441
US

V. Phone/Fax

Practice location:
  • Phone: 518-828-8733
  • Fax: 518-828-4898
Mailing address:
  • Phone: 484-686-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOEG003997
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberORT009681
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberORT009681
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003997
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: