Provider Demographics
NPI:1881118321
Name:LIEM, SOPHIA CLARISSA (OD)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:CLARISSA
Last Name:LIEM
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 1:2031 W ALAMEDA AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2960
Mailing Address - Country:US
Mailing Address - Phone:818-762-0647
Mailing Address - Fax:
Practice Address - Street 1:2031 W ALAMEDA AVE STE 300
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2960
Practice Address - Country:US
Practice Address - Phone:818-762-0647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33761TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist