MEDICARE: NGUYET THAI LESOLTIS 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	OPT5336	MA
2	152W00000X	Optometrist	008854	NY

General Provider Information

NPI Number	:	1407316102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGUYET THAI LESOLTIS OD

Provider Business Mailing Address
First Line	:	12 ELIOT ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-5824
Country	:	US
Telephone Number	:	617-354-3303
Fax Number	:	617-355-3290

Provider Business Practice Location Address
First Line	:	12 ELIOT ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02138-5824
Country	:	US
Telephone Number	:	617-354-3303
Fax Number	:	617-355-3290

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

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	02/05/2026

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Directions to “ NGUYET THAI LESOLTIS OD” Practice Location

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