Provider Demographics
NPI:1215343017
Name:LIU, ANDREA J (OD, FAAO)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:J
Last Name:LIU
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11672 N VIA VENITZIA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-7035
Mailing Address - Country:US
Mailing Address - Phone:408-309-5171
Mailing Address - Fax:
Practice Address - Street 1:3772 HOWE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5311
Practice Address - Country:US
Practice Address - Phone:510-752-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6295152W00000X
CA15335152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist