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: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 LOCUST ST
PITTSBURGH PA
15219-5924
US

IV. Provider business mailing address

1222 E END AVE
PITTSBURGH PA
15218-1310
US

V. Phone/Fax

Practice location:
  • Phone: 412-647-2200
  • Fax:
Mailing address:
  • Phone: 484-686-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV009681
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOEG003997
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003997
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: