Provider Demographics
NPI:1811026982
Name:LIU, MICO KUO (OD)
Entity Type:Individual
Prefix:DR
First Name:MICO
Middle Name:KUO
Last Name:LIU
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 1:287 AMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2470
Mailing Address - Country:US
Mailing Address - Phone:626-589-8696
Mailing Address - Fax:
Practice Address - Street 1:8500 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-3788
Practice Address - Country:US
Practice Address - Phone:562-801-9532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12407T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist