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NPI Code Detail

MEDICARE: DR. JILL LIU O.D.

MEDICARE: DR. JILL LIU O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist6509TGTX

General Provider Information

NPI Number : 1073516324
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JILL LIU O.D.
Provider Business Mailing Address
First Line : 402 SAWDUST RD
Second Line :
City : THE WOODLANDS
State : TX
Zip : 77380-2243
Country : US
Telephone Number : 281-363-2020
Fax Number : 281-367-2769
Provider Business Practice Location Address
First Line : 402 SAWDUST RD
Second Line :
City : THE WOODLANDS
State : TX
Zip : 77380-2243
Country : US
Telephone Number : 281-363-2020
Fax Number : 281-367-2769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2005
Last Update Date : 03/24/2010

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