Provider Demographics
NPI:1508175415
Name:LI, WEIDONG (OD)
Entity Type:Individual
Prefix:
First Name:WEIDONG
Middle Name:
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 1:1714 GRAND CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-8396
Mailing Address - Country:US
Mailing Address - Phone:972-731-8677
Mailing Address - Fax:972-731-8635
Practice Address - Street 1:8801 OHIO DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2268
Practice Address - Country:US
Practice Address - Phone:972-731-8677
Practice Address - Fax:972-731-8635
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7305T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist