Provider Demographics
NPI:1487675369
Name:KWOK LI MD PA
Entity Type:Organization
Organization Name:KWOK LI MD PA
Other - Org Name:ADVANCED EYE CENTER OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KWOK
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-273-0606
Mailing Address - Street 1:PO BOX 270536
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77277-0536
Mailing Address - Country:US
Mailing Address - Phone:936-293-0606
Mailing Address - Fax:
Practice Address - Street 1:9200 PINECROFT DR STE 455
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3280
Practice Address - Country:US
Practice Address - Phone:936-273-0606
Practice Address - Fax:936-273-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2418207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172127602Medicaid
TXH40049Medicare UPIN