Provider Demographics
NPI:1417525551
Name:LI, MAYLEA (OD)
Entity type:Individual
Prefix:DR
First Name:MAYLEA
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 HARVEY RD NE STE A
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4294
Mailing Address - Country:US
Mailing Address - Phone:206-883-8803
Mailing Address - Fax:
Practice Address - Street 1:921 HARVEY RD NE STE A
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4294
Practice Address - Country:US
Practice Address - Phone:253-833-2767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT0003703152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist