=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033474317
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR RYAN LE AND ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2012
-----------------------------------------------------
Last Update Date | 11/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 US HIGHWAY 34
-----------------------------------------------------
City | OSWEGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60543-7132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-554-5927
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1520 FRINGETREE LN
-----------------------------------------------------
City | WOODRIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60517-4653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-275-6247
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RYAN LE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-275-6247
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------