Provider Demographics
NPI:1114998622
Name:LI, DAWSON TO-SANG (OD)
Entity Type:Individual
Prefix:DR
First Name:DAWSON
Middle Name:TO-SANG
Last Name:LI
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 1:1002 WIBLE RD.
Mailing Address - Street 2:SUITE I
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304
Mailing Address - Country:US
Mailing Address - Phone:661-835-1104
Mailing Address - Fax:661-835-8644
Practice Address - Street 1:1002 WIBLE RD
Practice Address - Street 2:SUITE I
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-4137
Practice Address - Country:US
Practice Address - Phone:661-835-1104
Practice Address - Fax:661-835-8644
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11173 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0111730Medicaid
U88897Medicare UPIN