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General NPI Number Information
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NPI Number | 1083922017
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Entity Type | Organization
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Legal Business Name | SU-PEI LI OD LLC
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Dates
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Enumeration Date | 09/24/2010
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 3948 MORSE XING
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City | COLUMBUS
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State | OH
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Zip | 43219-6081
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Country | US
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Telephone | 614-563-0701
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Fax |
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Provider Business Mailing Address
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Address Line | 5724 NEWINGTON DR
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City | HILLIARD
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State | OH
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Zip | 43026-7915
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Country | US
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Telephone | 614-563-0701
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SU-PEI LI
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Credential | O.D.
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Telephone | 614-563-0701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5050/T1927
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License Number State | OH
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