Provider Demographics
NPI:1528418571
Name:LE, JAMIE QUEMAI THANH (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE QUEMAI
Middle Name:THANH
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 1:12187 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6502
Mailing Address - Country:US
Mailing Address - Phone:407-438-6682
Mailing Address - Fax:407-438-6683
Practice Address - Street 1:12187 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837
Practice Address - Country:US
Practice Address - Phone:407-438-6682
Practice Address - Fax:407-438-6683
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020273600Medicaid