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General NPI Number Information
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NPI Number | 1386807964
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Entity Type | Individual
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Provider Name | KELLEE LEANGSOK TEA OD
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Gender | Female
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 14361 BEACH BLVD STE 201
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City | WESTMINSTER
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State | CA
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Zip | 92683-8140
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Country | US
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Telephone | 714-684-1711
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Fax | 714-684-1920
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Provider Business Mailing Address
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Address Line | 14361 BEACH BLVD STE 201
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City | WESTMINSTER
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State | CA
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Zip | 92683-8140
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Country | US
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Telephone | 714-684-1711
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Fax | 714-775-7050
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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 | OEG002088
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 13559TLG
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License Number State | CA
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