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General NPI Number Information
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NPI Number | 1639434566
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Entity Type | Organization
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Legal Business Name | NICHOLAS LE OD LLC
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 07/06/2012
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Provider Practice Location Address
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Address Line | 4750 MILLENIA PLAZA WAY
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City | ORLANDO
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State | FL
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Zip | 32839-2434
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Country | US
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Telephone | 407-541-0021
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Fax |
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Provider Business Mailing Address
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Address Line | 4250 ALAFAYA TRL SUITE 212-311
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City | OVIEDO
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State | FL
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Zip | 32765-9412
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Country | US
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Telephone | 904-613-7503
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Fax |
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Authorized Official
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Title or Position | MANANGING MEMBER
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Name | NICHOLAS LE
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Credential | OD
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Telephone | 904-613-7503
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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 | OPC4337
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License Number State | FL
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