Provider Demographics
NPI:1396018719
Name:LEW AND LIAO A PROFESSIONAL OPTOMETRIC CORP.
Entity Type:Organization
Organization Name:LEW AND LIAO A PROFESSIONAL OPTOMETRIC CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-219-6768
Mailing Address - Street 1:1100 PARK PL STE 10
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-7106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 PARK PL STE 10
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-7106
Practice Address - Country:US
Practice Address - Phone:650-219-6768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty