Provider Demographics
NPI:1851443998
Name:LIEU, MEGAN M (OD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:M
Last Name:LIEU
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 1:10031 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-3137
Mailing Address - Country:US
Mailing Address - Phone:714-697-3220
Mailing Address - Fax:
Practice Address - Street 1:2831 PARK AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-2711
Practice Address - Country:US
Practice Address - Phone:714-258-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12917152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist