Provider Demographics
NPI:1922103217
Name:LIU, TING (OD)
Entity Type:Individual
Prefix:DR
First Name:TING
Middle Name:
Last Name:LIU
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 1:149 SEWICKLEY FARM CIR
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-7143
Mailing Address - Country:US
Mailing Address - Phone:724-467-2284
Mailing Address - Fax:
Practice Address - Street 1:1500 ECONOMY WAY
Practice Address - Street 2:
Practice Address - City:BADEN
Practice Address - State:PA
Practice Address - Zip Code:15005-1232
Practice Address - Country:US
Practice Address - Phone:724-390-9045
Practice Address - Fax:724-869-2829
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001342152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101057430001Medicaid
PA1553745OtherBLUE SHIELD PROVIDER NUMB
PA49458OtherDAVIS VISION PROVIDER NUM
PA101057430001Medicaid