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General NPI Number Information
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NPI Number | 1629635636
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Entity Type | Individual
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Provider Name | KIMBERLY DUY LE OD
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Gender | Female
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Dates
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Enumeration Date | 05/24/2019
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 300 E LAKE MEAD PKWY
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City | HENDERSON
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State | NV
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Zip | 89015-5576
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Country | US
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Telephone | 858-348-7790
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Fax |
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Provider Business Mailing Address
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Address Line | 8701 RED BROOK DR UNIT 204
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City | LAS VEGAS
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State | NV
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Zip | 89128-8455
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Country | US
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Telephone | 858-348-7790
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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 | 0NEWGRAD
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1019
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License Number State | NV
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