Provider Demographics
NPI:1023156643
Name:TRIEU, MA LE (OD)
Entity type:Individual
Prefix:
First Name:MA LE
Middle Name:
Last Name:TRIEU
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 1:134 KINGSLAND RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1915
Mailing Address - Country:US
Mailing Address - Phone:215-882-3879
Mailing Address - Fax:
Practice Address - Street 1:134 KINGSLAND RD STE 3
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1915
Practice Address - Country:US
Practice Address - Phone:973-405-2548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00630700152W00000X
NYTUV007689-1152W00000X
PAOEG001868152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0317446Medicaid
289872Medicare PIN