MEDICARE: DR. THANH T. LE O.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	06842TG	TX

General Provider Information

NPI Number	:	1346226917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THANH T. LE O.D

Provider Business Mailing Address
First Line	:	8410 DATAPOINT DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3220
Country	:	US
Telephone Number	:
Fax Number	:	210-949-8925

Provider Business Practice Location Address
First Line	:	8410 DATAPOINT DR
Second Line	:	EYE CLINIC
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3220
Country	:	US
Telephone Number	:	210-949-9733
Fax Number	:	201-949-8925

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	08/14/2013

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