Healthcare Provider Details

I. General information

NPI: 1225068992
Provider Name (Legal Business Name): SU PEI B LI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SU-PEI LI O.D., LLC

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3948 MORSE XING
COLUMBUS OH
43219-6081
US

IV. Provider business mailing address

5724 NEWINGTON DR
HILLIARD OH
43026-7915
US

V. Phone/Fax

Practice location:
  • Phone: 614-475-6512
  • Fax:
Mailing address:
  • Phone: 614-563-0701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5050T1927
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: