Provider Demographics
NPI:1578762415
Name:DIEN T LE OD PC
Entity Type:Organization
Organization Name:DIEN T LE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DIEN
Authorized Official - Middle Name:TRUY
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-455-0888
Mailing Address - Street 1:4500 W 38TH AVE
Mailing Address - Street 2:#130
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80212-2001
Mailing Address - Country:US
Mailing Address - Phone:303-455-0888
Mailing Address - Fax:303-455-0300
Practice Address - Street 1:4500 W 38TH AVE
Practice Address - Street 2:#130
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80212-2001
Practice Address - Country:US
Practice Address - Phone:303-455-0888
Practice Address - Fax:303-455-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC810948Medicare PIN