=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093881518
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VINCENT LEE UY O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10931 CHAPMAN AVE
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92840-3214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-741-3937
-----------------------------------------------------
Fax | 714-638-3689
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10931 CHAPMAN AVE
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92840-3214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-741-3937
-----------------------------------------------------
Fax | 714-638-3689
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT11838TPA
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------