Provider Demographics
NPI:1801915368
Name:LE, ERIC TUAN (OD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:TUAN
Last Name:LE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2808
Mailing Address - Country:US
Mailing Address - Phone:714-318-8477
Mailing Address - Fax:951-279-7375
Practice Address - Street 1:479 N MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1205
Practice Address - Country:US
Practice Address - Phone:951-272-0788
Practice Address - Fax:951-279-7375
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12770152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist