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General NPI Number Information
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NPI Number | 1689854028
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Entity Type | Organization
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Legal Business Name | JUDY C. LIAO O.D. INC
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 11/20/2015
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Provider Practice Location Address
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Address Line | 631 N BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90012-2801
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Country | US
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Telephone | 213-680-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 631 N BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90012-2801
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Country | US
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Telephone | 213-680-0404
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. JUDY C. LIAO
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Credential | O.D.
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Telephone | 213-680-0404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT 11694T
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License Number State | CA
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