Provider Demographics
NPI:1982661237
Name:LE, KRISTIN YEN (OD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:YEN
Last Name:LE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16910 THOMAS RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3956
Mailing Address - Country:US
Mailing Address - Phone:281-304-5060
Mailing Address - Fax:281-304-5070
Practice Address - Street 1:13611 SKINNER RD
Practice Address - Street 2:SUITE 155
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1018
Practice Address - Country:US
Practice Address - Phone:281-304-5060
Practice Address - Fax:281-304-5070
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6445TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6445TGOtherOPTOMETRY LICENSE
TXV07584Medicare UPIN
TX8F1829Medicare PIN