Healthcare Provider Details

I. General information

NPI: 1649609272
Provider Name (Legal Business Name): LE VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 BOSTON RD
BILLERICA MA
01821-5318
US

IV. Provider business mailing address

660 BOSTON RD
BILLERICA MA
01821-5318
US

V. Phone/Fax

Practice location:
  • Phone: 781-933-2820
  • Fax: 781-938-9567
Mailing address:
  • Phone: 781-933-2820
  • Fax: 781-938-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4707
License Number StateMA

VIII. Authorized Official

Name: DR. THUYANH DANG LE
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 781-933-2820