1982661237 NPI number — KRISTIN YEN LE O.D.

Table of content: KRISTIN YEN LE O.D. (NPI 1982661237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982661237 NPI number — KRISTIN YEN LE O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LE
Provider First Name:
KRISTIN
Provider Middle Name:
YEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1982661237
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16910 THOMAS RIDGE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CYPRESS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77433-3956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-304-5060
Provider Business Mailing Address Fax Number:
281-304-5070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13611 SKINNER RD
Provider Second Line Business Practice Location Address:
SUITE 155
Provider Business Practice Location Address City Name:
CYPRESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77429-1018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-304-5060
Provider Business Practice Location Address Fax Number:
281-304-5070
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  6445TG , 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: 6445TG . This is a "OPTOMETRY LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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