Healthcare Provider Details

I. General information

NPI: 1194932103
Provider Name (Legal Business Name): MR. ALAN S LI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 DUBLIN BLVD
DUBLIN CA
94568-7564
US

IV. Provider business mailing address

4540 DUBLIN BLVD
DUBLIN CA
94568-7564
US

V. Phone/Fax

Practice location:
  • Phone: 925-833-3937
  • Fax:
Mailing address:
  • Phone: 925-833-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberD7163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: