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General NPI Number Information
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NPI Number | 1730049529
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Entity Type | Individual
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Provider Name | ANTHONY ARCTURUS ODYSSEUS KANNING LE
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Gender | Male
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 3575 DONALD ST STE 110
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City | EUGENE
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State | OR
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Zip | 97405-4753
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Country | US
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Telephone | 541-248-4948
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Fax |
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Provider Business Mailing Address
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Address Line | 3575 DONALD ST STE 110
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City | EUGENE
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State | OR
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Zip | 97405-4753
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Country | US
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Telephone | 541-248-4984
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | BAP-E-10263651
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License Number State | OR
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