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NPI Code Detail

MEDICARE: JENNIFER LE

MEDICARE: JENNIFER 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
1152W00000XOptometristODTG00603RI
2152W00000XOptometrist5004MA

General Provider Information

NPI Number : 1538599014
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LE
Provider Business Mailing Address
First Line : 636 COLUMBIA RD
Second Line :
City : DORCHESTER
State : MA
Zip : 02125-3416
Country : US
Telephone Number : 617-825-9839
Fax Number :
Provider Business Practice Location Address
First Line : 636 COLUMBIA RD
Second Line :
City : DORCHESTER
State : MA
Zip : 02125-3416
Country : US
Telephone Number : 617-825-9839
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2013
Last Update Date : 01/05/2023

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Directions to “ JENNIFER LE ” Practice Location

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