Provider Demographics
NPI:1538462064
Name:WEIDONG LI, OD PA
Entity Type:Organization
Organization Name:WEIDONG LI, OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF STATE
Authorized Official - Prefix:
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-463-5555
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:
Mailing Address - Fax:
Practice Address - Street 1:782 E INTERSTATE 30
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5503
Practice Address - Country:US
Practice Address - Phone:972-772-6189
Practice Address - Fax:972-772-6189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7305T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty