MEDICARE: DR. DAVID Q LE O.D.

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	12393T	CA

General Provider Information

NPI Number	:	1275510927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID Q LE O.D.

Provider Business Mailing Address
First Line	:	1061 C ST STE 140
Second Line	:
City	:	GALT
State	:	CA
Zip	:	95632-1768
Country	:	US
Telephone Number	:	209-730-7477
Fax Number	:	209-334-6557

Provider Business Practice Location Address
First Line	:	1061 C ST STE 140
Second Line	:
City	:	GALT
State	:	CA
Zip	:	95632-1768
Country	:	US
Telephone Number	:	209-730-7477
Fax Number	:	209-334-6557

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	08/16/2015

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Directions to “ DR. DAVID Q LE O.D.” Practice Location

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