Healthcare Provider Details

I. General information

NPI: 1174442693
Provider Name (Legal Business Name): BRIAN LE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 MARTIN LUTHER KING JR WAY S STE 209
SEATTLE WA
98118-3593
US

IV. Provider business mailing address

13238 NE SPRING BLVD APT 414
BELLEVUE WA
98005-1467
US

V. Phone/Fax

Practice location:
  • Phone: 206-722-2218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD.OD.70148271
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: