Provider Demographics
NPI:1275510927
Name:LE, DAVID Q (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:Q
Last Name:LE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1061 C ST STE 140
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-1768
Mailing Address - Country:US
Mailing Address - Phone:209-730-7477
Mailing Address - Fax:209-334-6557
Practice Address - Street 1:1061 C ST STE 140
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-1768
Practice Address - Country:US
Practice Address - Phone:209-730-7477
Practice Address - Fax:209-334-6557
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12393T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV01803Medicare UPIN