Provider Demographics
NPI:1619719143
Name:LI, YUAN (OD)
Entity type:Individual
Prefix:
First Name:YUAN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2211 LOMAS BLVD NE FL 1
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2719
Mailing Address - Country:US
Mailing Address - Phone:505-272-4691
Mailing Address - Fax:
Practice Address - Street 1:2211 LOMAS BLVD NE FL 1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2719
Practice Address - Country:US
Practice Address - Phone:505-272-4691
Practice Address - Fax:505-277-1363
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMOPT-2025-0011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist