Provider Demographics
NPI:1528043932
Name:LE, STACEY Q T
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:Q T
Last Name:LE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7038 KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680
Mailing Address - Country:US
Mailing Address - Phone:714-895-4899
Mailing Address - Fax:714-895-6337
Practice Address - Street 1:7038 KATELLA AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680
Practice Address - Country:US
Practice Address - Phone:714-895-4899
Practice Address - Fax:714-895-6337
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP10232T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist