Provider Demographics
NPI:1548485758
Name:LIU, GWO BIN (OD)
Entity type:Individual
Prefix:DR
First Name:GWO
Middle Name:BIN
Last Name:LIU
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1116 W RANDOL MILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-6505
Mailing Address - Country:US
Mailing Address - Phone:817-861-9496
Mailing Address - Fax:
Practice Address - Street 1:1116 W RANDOL MILL RD STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-6505
Practice Address - Country:US
Practice Address - Phone:817-861-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4377152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1123846-02Medicaid
TX1123846-02Medicaid