Provider Demographics
NPI:1346593324
Name:EDDIE LI OD PC
Entity Type:Organization
Organization Name:EDDIE LI OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:848-565-8904
Mailing Address - Street 1:7525 153RD ST
Mailing Address - Street 2:#147
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7525 153RD ST
Practice Address - Street 2:#147
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3090
Practice Address - Country:US
Practice Address - Phone:848-565-8904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007896152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty