Provider Demographics
NPI:1447267885
Name:LIU, JESSIE LI-WEI (OD)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:LI-WEI
Last Name:LIU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 965
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-0965
Mailing Address - Country:US
Mailing Address - Phone:510-473-7878
Mailing Address - Fax:
Practice Address - Street 1:1098 ALDER AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4318
Practice Address - Country:US
Practice Address - Phone:360-659-6255
Practice Address - Fax:360-653-2466
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13119152W00000X
WAOD60304885152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist