Provider Demographics
NPI:1740423359
Name:PAM E. BAE-LI, O.D., LLC
Entity Type:Organization
Organization Name:PAM E. BAE-LI, O.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAE-LI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-785-6547
Mailing Address - Street 1:14402 ASHLEIGH GREENE RD
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-4377
Mailing Address - Country:US
Mailing Address - Phone:301-785-6547
Mailing Address - Fax:301-258-0214
Practice Address - Street 1:701 RUSSELL AVE
Practice Address - Street 2:JCPENNEY OPTICAL
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2631
Practice Address - Country:US
Practice Address - Phone:240-631-1332
Practice Address - Fax:301-258-0214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 1551152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty