Healthcare Provider Details

I. General information

NPI: 1699376178
Provider Name (Legal Business Name): VIVIAN LE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 PRESTON RD STE B
PLANO TX
75093-2315
US

IV. Provider business mailing address

2101 PRESTON RD STE B
PLANO TX
75093-2315
US

V. Phone/Fax

Practice location:
  • Phone: 817-940-0039
  • Fax: 214-919-4906
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11125
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: