MEDICARE: DR. DIANE LE YANG 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	12831T	CA

General Provider Information

NPI Number	:	1790775674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE LE YANG O.D.

Provider Business Mailing Address
First Line	:	7276 KAMWOOD ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-5146
Country	:	US
Telephone Number	:	858-586-1758
Fax Number	:	858-586-1758

Provider Business Practice Location Address
First Line	:	5405 UNIVERSITY AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-2304
Country	:	US
Telephone Number	:	619-229-6689
Fax Number	:	619-286-1659

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/08/2007

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