MEDICARE: DR. MINH NHAT VU LE OPTOMETRIST

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	OPT11843T	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CD605Z	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1316936792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINH NHAT VU LE OPTOMETRIST

Provider Business Mailing Address
First Line	:	1652 E CAPITOL EXPY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1839
Country	:	US
Telephone Number	:	408-528-0991
Fax Number	:	408-528-0994

Provider Business Practice Location Address
First Line	:	1652 E CAPITOL EXPY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1839
Country	:	US
Telephone Number	:	408-528-0991
Fax Number	:	408-528-0994

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	01/08/2010

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