Provider Demographics
NPI:1346405487
Name:LI, TING (OD)
Entity Type:Individual
Prefix:
First Name:TING
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 VAHALLA DR
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-5260
Mailing Address - Country:US
Mailing Address - Phone:440-248-1534
Mailing Address - Fax:
Practice Address - Street 1:10000 BROOKPARK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-1102
Practice Address - Country:US
Practice Address - Phone:216-382-2562
Practice Address - Fax:216-382-2569
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5799 T2713152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3041658Medicaid
OH3041658Medicaid