Basic Information
| Provider Information | |||||||||
| NPI: | 1508175415 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LI | ||||||||
| FirstName: | WEIDONG | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1714 GRAND CANYON WAY | ||||||||
| Address2: | |||||||||
| City: | ALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750028396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727318677 | ||||||||
| FaxNumber: | 9727318635 | ||||||||
| Practice Location | |||||||||
| Address1: | 8801 OHIO DR | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750242268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727318677 | ||||||||
| FaxNumber: | 9727318635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2010 | ||||||||
| LastUpdateDate: | 05/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 7305T | TX | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.