Provider Demographics
NPI:1073516324
Name:LIU, JILL (OD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 SAWDUST RD
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2243
Mailing Address - Country:US
Mailing Address - Phone:281-363-2020
Mailing Address - Fax:281-367-2769
Practice Address - Street 1:402 SAWDUST RD
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2243
Practice Address - Country:US
Practice Address - Phone:281-363-2020
Practice Address - Fax:281-367-2769
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6509TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV01758Medicare UPIN
TX8J0214Medicare PIN
TX8J0320Medicare PIN
TX8J0213Medicare PIN
TX8C6434Medicare ID - Type Unspecified
TX8J2011Medicare PIN
TX8J0212Medicare PIN
TX8F23946Medicare PIN