Provider Demographics
NPI:1083797666
Name:LIU, JEANNETTE LUCILLE (OD)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:LUCILLE
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 1:9617 SLOWAY COAST DR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2789
Mailing Address - Country:US
Mailing Address - Phone:703-495-8226
Mailing Address - Fax:
Practice Address - Street 1:6701 LOISDALE RD
Practice Address - Street 2:SUITE S
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1902
Practice Address - Country:US
Practice Address - Phone:703-719-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001093152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist