Provider Demographics
NPI:1821340779
Name:LE, KIM-ANH (OD)
Entity Type:Individual
Prefix:MS
First Name:KIM-ANH
Middle Name:
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 1:388 RUE DE GABRIEL APT C9
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-8265
Mailing Address - Country:US
Mailing Address - Phone:225-892-3404
Mailing Address - Fax:
Practice Address - Street 1:388 RUE DE GABRIEL APT C9
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-8265
Practice Address - Country:US
Practice Address - Phone:225-892-3404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1640-674T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist