Provider Demographics
NPI:1497060875
Name:LIAO, YUANBING (OD)
Entity Type:Individual
Prefix:MS
First Name:YUANBING
Middle Name:
Last Name:LIAO
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 1:3028 CASTRO VALLEY BLVD.
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5510
Mailing Address - Country:US
Mailing Address - Phone:510-538-2020
Mailing Address - Fax:844-270-2826
Practice Address - Street 1:3028 CASTRO VALLEY BLVD.
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5510
Practice Address - Country:US
Practice Address - Phone:510-538-2020
Practice Address - Fax:844-270-2826
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 14020 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA117987OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN)