Provider Demographics
NPI:1689675720
Name:LIU, JUDY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:C
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 N TOWN CENTER DR STE 518
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0519
Mailing Address - Country:US
Mailing Address - Phone:702-369-0200
Mailing Address - Fax:702-243-8383
Practice Address - Street 1:710 CORONADO CENTER DR STE 201
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4291
Practice Address - Country:US
Practice Address - Phone:702-369-0200
Practice Address - Fax:702-243-8383
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16454207W00000X, 207W00000X
AZ35642207W00000X
MI4301104090207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1689675720Medicaid
AZ109712Medicaid
MIM21980030Medicare PIN
MI1689675720Medicaid
AZ110090Medicare PIN
PA1022146530001Medicaid