MEDICARE: TRACY THAO 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	OPT11478T	CA

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	:	1396730719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY THAO LE O.D.

Provider Business Mailing Address
First Line	:	3331 NORWOOD AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95148-2712
Country	:	US
Telephone Number	:	408-259-1818
Fax Number	:	408-259-1871

Provider Business Practice Location Address
First Line	:	301 N JACKSON AVE
Second Line	:	SUITE 1
City	:	SAN JOSE
State	:	CA
Zip	:	95133-2344
Country	:	US
Telephone Number	:	408-259-1818
Fax Number	:	408-259-1871

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/08/2007

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Directions to “ TRACY THAO LE O.D.” Practice Location

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