Provider Demographics
NPI:1114656972
Name:LIU, JENNIFER JING (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JING
Last Name:LIU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1222 E END AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1310
Mailing Address - Country:US
Mailing Address - Phone:484-686-6021
Mailing Address - Fax:
Practice Address - Street 1:1622 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-5924
Practice Address - Country:US
Practice Address - Phone:412-647-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV009681152W00000X
PAOEG003997152WL0500X, 152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty