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General NPI Number Information
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NPI Number | 1225552599
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Entity Type | Individual
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Provider Name | MICHELLE LE TAN OD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2017
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 530 E MAIN ST
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City | PURCELLVILLE
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State | VA
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Zip | 20132-3171
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Country | US
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Telephone | 540-338-1833
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Fax |
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Provider Business Mailing Address
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Address Line | 12256 PARKSTREAM TER
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City | HERNDON
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State | VA
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Zip | 20170-2533
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Country | US
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Telephone | 571-201-1159
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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 | 0618002586
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License Number State | VA
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