Provider Demographics
NPI:1235268707
Name:LE, TAM THI (OD)
Entity Type:Individual
Prefix:DR
First Name:TAM
Middle Name:THI
Last Name:LE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33355 PITMAN LN
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7619
Mailing Address - Country:US
Mailing Address - Phone:760-670-6775
Mailing Address - Fax:
Practice Address - Street 1:41200 MURRIETA HOT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9479
Practice Address - Country:US
Practice Address - Phone:951-696-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12951T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist