Provider Demographics
NPI:1346422664
Name:LANCE LE OPTOMETRY SERVICES, P.C.
Entity Type:Organization
Organization Name:LANCE LE OPTOMETRY SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-663-3937
Mailing Address - Street 1:14999 PRESTON RD
Mailing Address - Street 2:SUITE 220D
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-9116
Mailing Address - Country:US
Mailing Address - Phone:972-663-3937
Mailing Address - Fax:972-663-3938
Practice Address - Street 1:14999 PRESTON RD
Practice Address - Street 2:SUITE 220D
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-9116
Practice Address - Country:US
Practice Address - Phone:972-663-3937
Practice Address - Fax:972-663-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6124T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00217TMedicare PIN