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General NPI Number Information
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NPI Number | 1124361100
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Entity Type | Organization
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Legal Business Name | ELITE FAMILY EYE CARE, OD, PLLC
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 03/28/2013
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Provider Practice Location Address
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Address Line | 2339 US HIGHWAY 70 SE
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City | HICKORY
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State | NC
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Zip | 28602-8300
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Country | US
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Telephone | 919-608-2579
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Fax |
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Provider Business Mailing Address
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Address Line | 2339 US HIGHWAY 70 SE
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City | HICKORY
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State | NC
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Zip | 28602-8300
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. YUPHENG LY
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Credential | O.D.
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Telephone | 919-608-2579
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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 | 2206
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License Number State | NC
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