Provider Demographics
NPI:1699797746
Name:LIU, HALLE PHUONG (OD)
Entity type:Individual
Prefix:DR
First Name:HALLE
Middle Name:PHUONG
Last Name:LIU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:HALLE
Other - Middle Name:PHUONG
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1701 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4580
Practice Address - Country:US
Practice Address - Phone:972-713-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6612TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612495Medicare ID - Type Unspecified