Healthcare Provider Details

I. General information

NPI: 1023156643
Provider Name (Legal Business Name): MA LE TRIEU OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 RIVER RD
EDGEWATER NJ
07020-1145
US

IV. Provider business mailing address

449 RIVER RD
EDGEWATER NJ
07020-1145
US

V. Phone/Fax

Practice location:
  • Phone: 201-654-9055
  • Fax:
Mailing address:
  • Phone: 201-654-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV007689-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001868
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00630700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: