Healthcare Provider Details

I. General information

NPI: 1568796092
Provider Name (Legal Business Name): LE MY DUONG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 WESTMINSTER AVE SUITE D
SANTA ANA CA
92706-2143
US

IV. Provider business mailing address

2525 WESTMINSTER AVE SUITE D
SANTA ANA CA
92706
UM

V. Phone/Fax

Practice location:
  • Phone: 714-884-4221
  • Fax: 714-884-3632
Mailing address:
  • Phone: 714-884-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13753 TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: