Provider Demographics
NPI:1114216249
Name:LIAO, JEWEL (MD)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3114 TELEGRAPH RD
Mailing Address - Street 2:STE A
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3219
Mailing Address - Country:US
Mailing Address - Phone:805-648-6891
Mailing Address - Fax:805-648-6386
Practice Address - Street 1:3114 TELEGRAPH RD
Practice Address - Street 2:STE A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3219
Practice Address - Country:US
Practice Address - Phone:805-648-6891
Practice Address - Fax:805-648-6386
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY268709207W00000X
CAC171723207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400161862Medicare PIN