Provider Demographics
NPI:1851429369
Name:LI, LORETTA MUI-WAN (OD)
Entity Type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:MUI-WAN
Last Name:LI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9022 BOLSA AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5531
Mailing Address - Country:US
Mailing Address - Phone:714-892-3636
Mailing Address - Fax:714-892-6273
Practice Address - Street 1:9022 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5531
Practice Address - Country:US
Practice Address - Phone:714-892-3636
Practice Address - Fax:714-892-6273
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7514T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0075140Medicaid
CASD0075140Medicaid
OP7514Medicare ID - Type Unspecified