Provider Demographics
NPI:1821128091
Name:LE, RICHARD H (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:LE
Suffix:
Gender:M
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:PO BOX 630856
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-0136
Mailing Address - Country:US
Mailing Address - Phone:817-738-9600
Mailing Address - Fax:817-738-9650
Practice Address - Street 1:2112 GREEN OAKS RD
Practice Address - Street 2:SUITE B
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-1705
Practice Address - Country:US
Practice Address - Phone:817-738-9600
Practice Address - Fax:817-738-9650
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4994T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141848764 76116 A002OtherTRICARE PROVIDER NUMBER
TX141848764 76116 A002OtherTRICARE PROVIDER NUMBER
TXU94370Medicare UPIN