Provider Demographics
NPI:1194392274
Name:LE, DUNG VIET (OD)
Entity Type:Individual
Prefix:
First Name:DUNG
Middle Name:VIET
Last Name:LE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 S ZARZAMORA ST STE 107B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1111
Mailing Address - Country:US
Mailing Address - Phone:210-251-1398
Mailing Address - Fax:
Practice Address - Street 1:6915 S ZARZAMORA ST STE 107B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1111
Practice Address - Country:US
Practice Address - Phone:210-251-1398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX10304152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty