Provider Demographics
NPI:1083767164
Name:LIANG, JANE (OD)
Entity Type:Individual
Prefix:DR
First Name:JANE
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 1:2115 S HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4243
Mailing Address - Country:US
Mailing Address - Phone:626-330-4115
Mailing Address - Fax:626-330-4116
Practice Address - Street 1:2115 S HACIENDA BLVD
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-4243
Practice Address - Country:US
Practice Address - Phone:626-330-4115
Practice Address - Fax:626-330-4116
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11266T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA13690OtherMEDICAL EYE SERVICES
CA4049OtherSUPERIOR VISION
CASD0112661Medicaid
CACA1266OtherEYE MED
CAFV25028OtherSPECTERA
CA49807OtherDAVIS VISION
CA6263304115OtherVISION SERVICE PLAN
CACA1266OtherEYE MED