Provider Demographics
NPI:1205149549
Name:TAM T LE OD INC
Entity type:Organization
Organization Name:TAM T LE OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAM
Authorized Official - Middle Name:THI
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-670-6775
Mailing Address - Street 1:1711 E VALLEY PKWY
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2521
Mailing Address - Country:US
Mailing Address - Phone:760-737-6064
Mailing Address - Fax:760-737-6064
Practice Address - Street 1:1711 E VALLEY PKWY
Practice Address - Street 2:SUITE 109
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-2521
Practice Address - Country:US
Practice Address - Phone:760-737-6064
Practice Address - Fax:760-737-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-15
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12951T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty