1396072799 NPI number — TUAN K LE

Table of content: (NPI 1396072799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396072799 NPI number — TUAN K LE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TUAN K LE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396072799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1809 ELDRIDGE PKWY
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77077-2549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-496-9615
Provider Business Mailing Address Fax Number:
281-496-9685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1809 ELDRIDGE PKWY
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77077-2549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-496-9615
Provider Business Practice Location Address Fax Number:
281-496-9685
Provider Enumeration Date:
11/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
TUAN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT/OD
Authorized Official Telephone Number:
281-496-9615

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  6716TG , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6716TG . This is a "TEXAS OPTOMETRY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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