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General NPI Number Information
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NPI Number | 1205149549
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Entity Type | Organization
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Legal Business Name | TAM T LE OD INC
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 1711 E VALLEY PKWY SUITE 109
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City | ESCONDIDO
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State | CA
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Zip | 92027-2521
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Country | US
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Telephone | 760-737-6064
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Fax | 760-737-6064
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Provider Business Mailing Address
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Address Line | 1711 E VALLEY PKWY SUITE 109
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City | ESCONDIDO
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State | CA
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Zip | 92027-2521
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Country | US
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Telephone | 760-737-6064
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Fax | 760-737-6064
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Authorized Official
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Title or Position | OWNER
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Name | DR. TAM THI LE
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Credential | O.D.
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Telephone | 760-670-6775
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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 | 12951T
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License Number State | CA
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