Provider Demographics
NPI:1154406866
Name:TONY C LIEU OPTOMETRIC PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:TONY C LIEU OPTOMETRIC PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIEU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-898-6979
Mailing Address - Street 1:3833 BEDFORD CANYON RD
Mailing Address - Street 2:STE #C-101
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-0788
Mailing Address - Country:US
Mailing Address - Phone:951-898-6979
Mailing Address - Fax:888-818-4787
Practice Address - Street 1:3833 BEDFORD CANYON RD
Practice Address - Street 2:STE #C-101
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-0788
Practice Address - Country:US
Practice Address - Phone:951-898-6979
Practice Address - Fax:888-818-4787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11916152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU95897Medicare UPIN