Provider Demographics
NPI:1093272700
Name:MICHAEL D LE OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:MICHAEL D LE OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-322-6656
Mailing Address - Street 1:109 CALIFORNIA AVE STE D101A
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1926
Mailing Address - Country:US
Mailing Address - Phone:650-322-6656
Mailing Address - Fax:
Practice Address - Street 1:109 CALIFORNIA AVE STE D101A
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1926
Practice Address - Country:US
Practice Address - Phone:650-322-6656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1437591500OtherNPI
CA1871554113OtherNPI
CA1093147092OtherNPI