Provider Demographics
NPI:1750627576
Name:ALEX CORBIN LIU, OD. INC.
Entity type:Organization
Organization Name:ALEX CORBIN LIU, OD. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:CORBIN
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-367-9103
Mailing Address - Street 1:6740 WHITE CLOVER WAY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9170
Mailing Address - Country:US
Mailing Address - Phone:626-367-9103
Mailing Address - Fax:909-468-4603
Practice Address - Street 1:19735 COLIMA RD
Practice Address - Street 2:#4
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-3227
Practice Address - Country:US
Practice Address - Phone:909-468-4622
Practice Address - Fax:909-468-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12329T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty