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General NPI Number Information
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NPI Number | 1790459238
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Entity Type | Individual
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Provider Name | MING XUAN LI OD
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Gender | Male
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Dates
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Enumeration Date | 08/08/2021
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 139 CENTRE ST
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City | NEW YORK
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State | NY
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Zip | 10013-4552
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Country | US
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Telephone | 212-219-2219
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Fax |
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Provider Business Mailing Address
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Address Line | 93 MADISON ST APT 3A
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City | NEW YORK
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State | NY
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Zip | 10002-7239
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Country | US
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Telephone | 857-350-5271
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | TUV009379-01
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License Number State | NY
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