Provider Demographics
NPI:1295162642
Name:LIU, WENSHAN (OD)
Entity type:Individual
Prefix:DR
First Name:WENSHAN
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 1:15051 HESPERIAN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3536
Mailing Address - Country:US
Mailing Address - Phone:510-276-1212
Mailing Address - Fax:
Practice Address - Street 1:62968 O B RILEY RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-9442
Practice Address - Country:US
Practice Address - Phone:541-382-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4588152W00000X, 152W00000X
CA14754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist