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General NPI Number Information
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NPI Number | 1750627576
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Entity Type | Organization
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Legal Business Name | ALEX CORBIN LIU, OD. INC.
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Dates
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Enumeration Date | 12/26/2012
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Last Update Date | 12/26/2012
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Provider Practice Location Address
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Address Line | 19735 COLIMA RD #4
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City | ROWLAND HEIGHTS
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State | CA
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Zip | 91748-3227
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Country | US
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Telephone | 909-468-4622
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Fax | 909-468-4603
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Provider Business Mailing Address
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Address Line | 6740 WHITE CLOVER WAY
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City | CORONA
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State | CA
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Zip | 92880-9170
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Country | US
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Telephone | 626-367-9103
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Fax | 909-468-4603
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEX CORBIN LIU
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Credential | O.D.
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Telephone | 626-367-9103
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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 | 12329T
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License Number State | CA
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