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General NPI Number Information
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NPI Number | 1801915368
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Entity Type | Individual
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Provider Name | ERIC TUAN LE O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 479 N MCKINLEY ST
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City | CORONA
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State | CA
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Zip | 92879-1205
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Country | US
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Telephone | 951-272-0788
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Fax | 951-279-7375
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Provider Business Mailing Address
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Address Line | 1060 CONCORD ST
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City | COSTA MESA
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State | CA
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Zip | 92626-2808
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Country | US
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Telephone | 714-318-8477
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Fax | 951-279-7375
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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 | 12770
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License Number State | CA
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