=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770787103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QI CHAO LUI INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 158 7TH AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11215-2244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-399-1825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 420 JEFFERSON ST APT 3F
-----------------------------------------------------
City | HOBOKEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07030-2666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-675-1173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. QI CHAO LUI
-----------------------------------------------------
Credential | O.D
-----------------------------------------------------
Telephone | 646-675-1173
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | TUV00673
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------