Provider Demographics
NPI:1902827488
Name:LE, THUY (OD)
Entity Type:Individual
Prefix:
First Name:THUY
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 1:29 LANCELOT DR
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1261
Mailing Address - Country:US
Mailing Address - Phone:508-363-3937
Mailing Address - Fax:508-363-3938
Practice Address - Street 1:29 LANCELOT DR
Practice Address - Street 2:
Practice Address - City:PAXTON
Practice Address - State:MA
Practice Address - Zip Code:01612-1261
Practice Address - Country:US
Practice Address - Phone:508-363-3937
Practice Address - Fax:508-363-3938
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4331152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0336301Medicaid
MA0336301Medicaid
MAW17627Medicare PIN
MAW21069Medicare PIN