Provider Demographics
NPI:1356532600
Name:LE, PHUONG TC (OD)
Entity type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:TC
Last Name:LE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:9600 BOLSA AVE STE C&H
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5949
Mailing Address - Country:US
Mailing Address - Phone:714-775-7045
Mailing Address - Fax:714-775-7050
Practice Address - Street 1:9600 BOLSA AVE
Practice Address - Street 2:SUITE C AND H
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5949
Practice Address - Country:US
Practice Address - Phone:714-775-7045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2536152W00000X
CA13375152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist