Provider Demographics
NPI:1225068992
Name:LI, SU PEI B (OD)
Entity Type:Individual
Prefix:DR
First Name:SU PEI
Middle Name:B
Last Name:LI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SU-PEI
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD, LLC
Mailing Address - Street 1:5724 NEWINGTON DR
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7915
Mailing Address - Country:US
Mailing Address - Phone:614-563-0701
Mailing Address - Fax:
Practice Address - Street 1:3948 MORSE XING
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6081
Practice Address - Country:US
Practice Address - Phone:614-475-6512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5050T1927152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11313528OtherCAQH
U83489Medicare UPIN
OHLI4040511Medicare PIN
OHLI4040512Medicare PIN