Provider Demographics
NPI:1770923039
Name:LI, JUANA (OD)
Entity type:Individual
Prefix:DR
First Name:JUANA
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2020 COLORADO AVE.
Mailing Address - Street 2:SUITE A
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382
Mailing Address - Country:US
Mailing Address - Phone:092-667-6211
Mailing Address - Fax:209-667-2574
Practice Address - Street 1:2020 COLORADO AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2002
Practice Address - Country:US
Practice Address - Phone:209-667-6211
Practice Address - Fax:209-667-2574
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14410TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist