Provider Demographics
NPI:1063768133
Name:LIU, JOANNA L (OD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:L
Last Name:LIU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11606 NICHOLAS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4478
Mailing Address - Country:US
Mailing Address - Phone:402-493-3712
Mailing Address - Fax:402-493-8341
Practice Address - Street 1:11606 NICHOLAS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4478
Practice Address - Country:US
Practice Address - Phone:402-493-3712
Practice Address - Fax:402-493-8341
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1382152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist