MEDICARE: MA LE TRIEU OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	27OA00630700	NJ
2	152W00000X	Optometrist	TUV007689-1	NY
3	152W00000X	Optometrist	OEG001868	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023156643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MA LE TRIEU OD

Provider Business Mailing Address
First Line	:	134 KINGSLAND RD STE 3
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07014-1915
Country	:	US
Telephone Number	:	215-882-3879
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 KINGSLAND RD STE 3
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07014-1915
Country	:	US
Telephone Number	:	973-405-2548
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2007
Last Update Date	:	05/10/2023

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