Healthcare Provider Details

I. General information

NPI: 1265847990
Provider Name (Legal Business Name): EMILY YUWEN LIU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 VETERANS DR SW
TACOMA WA
98493-0003
US

IV. Provider business mailing address

9600 VETERANS DR SW
TACOMA WA
98493-0003
US

V. Phone/Fax

Practice location:
  • Phone: 408-761-8602
  • Fax:
Mailing address:
  • Phone: 408-627-7021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14992
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD60479528
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: