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General NPI Number Information
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NPI Number | 1215127550
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Entity Type | Organization
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Legal Business Name | LORETTA M LI OD
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 9022 BOLSA AVE
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City | WESTMINSTER
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State | CA
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Zip | 92683
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Country | US
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Telephone | 714-892-3636
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Fax | 714-892-6273
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Provider Business Mailing Address
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Address Line | 9022 BOLSA AVE
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City | WESTMINSTER
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State | CA
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Zip | 92683
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Country | US
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Telephone | 714-892-3636
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Fax | 714-892-6273
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Authorized Official
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Title or Position | OWNER
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Name | DR. LORETTA MUI WAN LI
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Credential | OD
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Telephone | 714-892-3636
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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 | 124597
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 75147
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License Number State | CA
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