=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356015044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LI & LIAO OPTOMETRY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2021
-----------------------------------------------------
Last Update Date | 08/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5649 GOSFORD RD STE 300&400
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93313-6189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-432-1820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5649 GOSFORD RD STE 300&400
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93313-6189
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMIN
-----------------------------------------------------
Name | KAELI VELASCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 661-213-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------