MEDICARE: DR. QI CHAO LUI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV006793	NY

General Provider Information

NPI Number	:	1619171048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QI CHAO LUI O.D.

Provider Business Mailing Address
First Line	:	44 NEWARK ST
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-5661
Country	:	US
Telephone Number	:	201-683-4228
Fax Number	:

Provider Business Practice Location Address
First Line	:	158 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2244
Country	:	US
Telephone Number	:	718-399-1825
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	11/16/2016

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