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General NPI Number Information
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NPI Number | 1770833196
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Entity Type | Individual
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Provider Name | CUC THI LE OD
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Gender | Female
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 151 SW 184TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-5465
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Country | US
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Telephone | 954-437-8777
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Fax |
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Provider Business Mailing Address
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Address Line | 13 MATADOR LN
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City | DAVIE
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State | FL
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Zip | 33324-5518
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Country | US
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Telephone | 954-304-2724
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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 | OPC4752
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License Number State | FL
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