Provider Demographics
NPI:1841251238
Name:LI, LIYI (OD)
Entity type:Individual
Prefix:DR
First Name:LIYI
Middle Name:
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 1:18015 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2101
Mailing Address - Country:US
Mailing Address - Phone:347-733-8168
Mailing Address - Fax:212-599-3353
Practice Address - Street 1:9001 QUEENS BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4937
Practice Address - Country:US
Practice Address - Phone:718-595-2266
Practice Address - Fax:718-595-2292
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006592-1152W00000X
NJ27OA 00582400152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU99162Medicare UPIN
NJ077491Medicare ID - Type Unspecified