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General NPI Number Information
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NPI Number | 1568943264
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Entity Type | Individual
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Provider Name | DANNY CHEN LE O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 290 CODDINGTOWN CTR
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City | SANTA ROSA
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State | CA
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Zip | 95401-3506
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Country | US
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Telephone | 832-235-5624
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Fax |
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Provider Business Mailing Address
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Address Line | 12092 ADRIAN ST APT 5-307
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City | GARDEN GROVE
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State | CA
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Zip | 92840-4339
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Country | US
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Telephone | 832-235-5624
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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 | 34062TLG
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License Number State | CA
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