Provider Demographics
NPI:1578171799
Name:JU, ZHONGLIANG (OD)
Entity Type:Individual
Prefix:
First Name:ZHONGLIANG
Middle Name:
Last Name:JU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HEATHER WAY
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-3218
Mailing Address - Country:US
Mailing Address - Phone:347-459-4619
Mailing Address - Fax:
Practice Address - Street 1:1470 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-6745
Practice Address - Country:US
Practice Address - Phone:508-699-4429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5411152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110163537AMedicaid