Provider Demographics
NPI:1114353687
Name:SIM, VAN LE (OD)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:LE
Last Name:SIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:200 E CYPRESS AVE
Mailing Address - Street 2:LENSCRAFTERS AT MACY'S
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1149
Mailing Address - Country:US
Mailing Address - Phone:818-557-1659
Mailing Address - Fax:818-557-1697
Practice Address - Street 1:200 E CYPRESS AVE
Practice Address - Street 2:LENSCRAFTERS AT MACY'S
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1149
Practice Address - Country:US
Practice Address - Phone:818-557-0016
Practice Address - Fax:818-557-1697
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOPT14840-TLG152W00000X
CA14840TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist