Provider Demographics
NPI:1316225006
Name:LIAO, BETTY
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GREYROCK PL
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-3118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 GREYROCK PL
Practice Address - Street 2:LENSCRAFTERS
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-3118
Practice Address - Country:US
Practice Address - Phone:203-324-0935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002830152W00000X
NYTUVOO7724-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist