Provider Demographics
NPI:1083065692
Name:LIANG, BRENDA (OD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:LIANG
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 1:10 E MERRICK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5800
Mailing Address - Country:US
Mailing Address - Phone:516-825-7455
Mailing Address - Fax:516-825-1494
Practice Address - Street 1:10 E MERRICK RD STE 201
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:516-825-7455
Practice Address - Fax:516-825-1494
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist