Provider Demographics
NPI:1194294108
Name:LIEU, JULIA LE
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:LE
Last Name:LIEU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 NW 9TH AVE APT 515
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3467
Mailing Address - Country:US
Mailing Address - Phone:503-481-2974
Mailing Address - Fax:
Practice Address - Street 1:10021 NE CASCADES PKWY STE S-4B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-6818
Practice Address - Country:US
Practice Address - Phone:503-535-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist