Healthcare Provider Details

I. General information

NPI: 1528775699
Provider Name (Legal Business Name): KATIE K LI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15037 N SCOTTSDALE RD # J180
SCOTTSDALE AZ
85254-2289
US

IV. Provider business mailing address

15037 N SCOTTSDALE RD # J180
SCOTTSDALE AZ
85254-2289
US

V. Phone/Fax

Practice location:
  • Phone: 480-443-7601
  • Fax: 480-607-2969
Mailing address:
  • Phone: 480-443-7601
  • Fax: 480-607-2969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002644
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: