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General NPI Number Information
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NPI Number | 1669442000
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Entity Type | Individual
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Provider Name | DAI DAN LE O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 05/05/2017
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Provider Practice Location Address
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Address Line | 11011 LEE HWY
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City | FAIRFAX
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State | VA
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Zip | 22030-5002
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Country | US
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Telephone | 703-691-7584
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Fax | 703-691-9770
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Provider Business Mailing Address
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Address Line | PO BOX 806 SUITE 170-452
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City | MC LEAN
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State | VA
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Zip | 22101-0806
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Country | US
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Telephone | 703-622-7233
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Fax | 916-788-4536
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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 | 06018001141
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License Number State | VA
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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 | 0618001141
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License Number State | VA
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