MEDICARE: DR. LINDA LE

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	4901005477APP20	MI

General Provider Information

NPI Number	:	1053936039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA LE

Provider Business Mailing Address
First Line	:	1301 ORLEANS ST APT 1705
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-2996
Country	:	US
Telephone Number	:	248-759-9202
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 ORLEANS ST APT 1705
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-2996
Country	:	US
Telephone Number	:	248-759-9202
Fax Number	:

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

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	06/15/2020

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Directions to “ DR. LINDA LE ” Practice Location

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