MEDICARE: DR. CHANG QING LI OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OA00601700	NJ
2	152W00000X	Optometrist	TUV005757	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790707271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANG QING LI OD

Provider Business Mailing Address
First Line	:	7 WITHERSPOON WAY
Second Line	:
City	:	MARLBORO
State	:	NJ
Zip	:	07746-2708
Country	:	US
Telephone Number	:	732-431-2708
Fax Number	:	732-431-2708

Provider Business Practice Location Address
First Line	:	210 CANAL ST RM 503
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-4160
Country	:	US
Telephone Number	:	212-513-1338
Fax Number	:	212-619-2838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	04/30/2018

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