Individual
CONNIE C LIU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2248 D ST, LA VERNE, CA 91750-5403
(909) 593-3519
(909) 593-3521
Mailing address
2248 D ST, LA VERNE, CA 91750-5403
(909) 593-3519
(909) 593-3521
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
13043T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396859476
MEDI-CAL
—
Enumeration date
08/18/2006
Last updated
12/01/2021
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