Healthcare Provider Details

I. General information

NPI: 1598554891
Provider Name (Legal Business Name): TIMOTHY LE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2025
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 VETERANS DR SW
TACOMA WA
98493-0003
US

IV. Provider business mailing address

10908 SE KNAPP ST
PORTLAND OR
97266-5035
US

V. Phone/Fax

Practice location:
  • Phone: 253-583-1250
  • Fax:
Mailing address:
  • Phone: 503-473-4239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberATI4842
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: