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General NPI Number Information
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NPI Number | 1790667707
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Entity Type | Individual
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Provider Name | KEVIN TUAN LE OD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 205 W 87TH ST STE D
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City | CHICAGO
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State | IL
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Zip | 60620-1321
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Country | US
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Telephone | 773-496-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 2435 COMMERCE AVE BLDG 2200
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City | DULUTH
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State | GA
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Zip | 30096-4980
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Country | US
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Telephone |
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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 | 046.012001
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License Number State | IL
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