Provider Demographics
NPI:1629635636
Name:LE, KIMBERLY DUY (OD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DUY
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 1:8701 RED BROOK DR
Mailing Address - Street 2:UNIT 204
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-8455
Mailing Address - Country:US
Mailing Address - Phone:858-348-7790
Mailing Address - Fax:
Practice Address - Street 1:300 E LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5576
Practice Address - Country:US
Practice Address - Phone:858-348-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0NEWGRAD152W00000X
NV1019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist