DR. CHANG QING LI OD, NPI 1790707271 — NEW YORK (NY)

NPI 1790707271

13+ Years Experience Individual

DR. CHANG QING LI OD

07/24/2006
PROVIDER ENUMERATION DATE
04/30/2018
LAST UPDATE DATE
1790707271
NPI NUMBER

About DR. CHANG QING LI

Sole proprietor? Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor.

DR. CHANG QING LI is a provider established in NEW YORK, NY. The NPI number of DR. CHANG QING LI is 1790707271 and was assigned on 07/24/2006. The practitioners primary taxonomy code is: 152W00000X with license number: OA00601700 NJ .

Mailing address

  • City: MARLBORO
  • State: NJ
  • Postal code: 77462708
  • Phone: 7324312708
  • Fax: 7324312708
  • Address: 7 WITHERSPOON WAY

Primary Practice Address

  • Region : NEW YORK, NY
  • NPI : 1790707271
  • Phone : 2125131338
  • Fax : 2126192838
  • Postalcode : 100134160
  • Address : 210 CANAL ST RM 503

Additional identifiers

  • Identifier: 1824208
  • Code / Type : 5 - MEDICAID
  • Identifier state : NY

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Optometrist

  • Taxonomy code: 152W00000X
  • License number: OA00601700
  • License state: NJ

The taxonomy is not the primary taxonomy.

Taxonomy description: Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

Healthcare provider taxonomy #2 - Optometrist

  • Taxonomy code: 152W00000X
  • License number: TUV005757
  • License state: NY

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

Contacts:

Click to Show Map
  • DR. CHANG QING LI OD
  • Address : 210 CANAL ST RM 503
  • Region : NEW YORK, NY
  • NPI : 1790707271
  • Phone : 2125131338
  • Fax : 2126192838
  • Postalcode : 100134160

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address210 CANAL ST RM 503
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameNEW YORK
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameNY
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code100134160
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number2125131338
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number2126192838
The fax number associated with the location address of the provider being identified.
NPI1790707271
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1152W00000X
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
Provider Enumeration Date07/24/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated04/30/2018
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)DR. CHANG QING LI
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address7 WITHERSPOON WAY
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NameMARLBORO
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameNJ
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code77462708
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number7324312708
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number7324312708
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1152W00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Optometrist
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
Provider License Number 1OA00601700
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1NJ
Healthcare Provider Primary Taxonomy Switch 1N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 2152W00000X
Healthcare Provider Taxonomy 2Optometrist
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
Provider License Number 2TUV005757
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 2NY
Healthcare Provider Primary Taxonomy Switch 2Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 11824208
Other Provider Identifier #1
Other Provider Identifier Type 15
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1NY
Other Provider Identifier State #1
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorY
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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