=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598304446
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENNY HUONG LE, O.D., A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2019
-----------------------------------------------------
Last Update Date | 12/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44407 10TH ST W STE B
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93534-3345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-942-3849
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44407 10TH ST W STE B
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93534-3345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-942-3849
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. JENNY HUONG LE
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 661-942-3849
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------