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General NPI Number Information
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NPI Number | 1023156643
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Entity Type | Individual
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Provider Name | MA LE TRIEU OD
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Gender | Female
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Dates
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Enumeration Date | 02/03/2007
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 134 KINGSLAND RD STE 3
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City | CLIFTON
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State | NJ
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Zip | 07014-1915
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Country | US
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Telephone | 973-405-2548
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Fax |
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Provider Business Mailing Address
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Address Line | 134 KINGSLAND RD STE 3
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City | CLIFTON
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State | NJ
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Zip | 07014-1915
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Country | US
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Telephone | 215-882-3879
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00630700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV007689-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG001868
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License Number State | PA
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