Provider Demographics
NPI:1649584194
Name:LI, WING Y (OD)
Entity Type:Individual
Prefix:DR
First Name:WING
Middle Name:Y
Last Name:LI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ERIC
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1919 DWIGHT WAY
Mailing Address - Street 2:APT 311
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1969
Mailing Address - Country:US
Mailing Address - Phone:626-863-5132
Mailing Address - Fax:
Practice Address - Street 1:200 MINOR HALL
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-642-2020
Practice Address - Fax:510-642-8012
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13991152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist