Provider Demographics
NPI:1497814263
Name:PHUC V LE OPTOMETRY INC
Entity Type:Organization
Organization Name:PHUC V LE OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUC
Authorized Official - Middle Name:V
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-842-0101
Mailing Address - Street 1:6815 CAMINO ARROYO STE 60
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7077
Mailing Address - Country:US
Mailing Address - Phone:408-842-0101
Mailing Address - Fax:
Practice Address - Street 1:6815 CAMINO ARROYO STE 60
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7077
Practice Address - Country:US
Practice Address - Phone:408-842-0101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12744T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV09348Medicare UPIN