Healthcare Provider Details

I. General information

NPI: 1104230200
Provider Name (Legal Business Name): LILAN LE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8022 MELROSE AVE
LOS ANGELES CA
90046
US

IV. Provider business mailing address

8022 MELROSE AVE
LOS ANGELES CA
90046
US

V. Phone/Fax

Practice location:
  • Phone: 213-221-0552
  • Fax: 213-906-0079
Mailing address:
  • Phone: 213-221-0552
  • Fax: 213-906-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6963
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3312
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11345
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT15207-TLG
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003317
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number008146
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: