MEDICARE: THUY 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	4331	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902827488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THUY LE O.D.

Provider Business Mailing Address
First Line	:	29 LANCELOT DR
Second Line	:
City	:	PAXTON
State	:	MA
Zip	:	01612-1261
Country	:	US
Telephone Number	:	508-363-3937
Fax Number	:	508-363-3938

Provider Business Practice Location Address
First Line	:	29 LANCELOT DR
Second Line	:
City	:	PAXTON
State	:	MA
Zip	:	01612-1261
Country	:	US
Telephone Number	:	508-363-3937
Fax Number	:	508-363-3938

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/30/2013

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