Active NPI
Yan Li, O.D.
- Optometrist
- Woburn, MA
National Provider Identifier
1316047855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4235
- Practice address
- 101 Commerce Way
Target Optical
Woburn, MA 01801-1007 - Phone
- (781) 904-0005
- Fax
- (781) 904-0007
- NPI assigned
- Sep 24, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4235 | MA | Primary |
Addresses
Primary practice location
101 Commerce Way
Target Optical
Woburn, MA 01801-1007
Mailing address
31 Houlton St
Bedford, MA 01730-1901
Phone (781) 964-3840
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W16341 | Other | MA | BCBS |
| 0399868 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070501000093 | MA | Practitioner - Optometry | 9739285289 | Practice locations: Woburn, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- New England College of Optometry, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
101 Commerce Way
Woburn, MA 01801-1007
Phone (781) 904-0005
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4235 | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316047855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "31 HOULTON ST",
"city": "BEDFORD",
"state": "MA",
"postal_code": "017301901",
"telephone_number": "781-964-3840"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 COMMERCE WAY",
"address_2": "TARGET OPTICAL",
"city": "WOBURN",
"state": "MA",
"postal_code": "018011007",
"telephone_number": "781-904-0005",
"fax_number": "781-904-0007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LI",
"first_name": "YAN",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-09-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MA",
"license": "4235",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "W16341",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0399868",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woburn, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.