Provider Demographics
NPI:1912253386
Name:LE, HA TIEN (OD)
Entity Type:Individual
Prefix:
First Name:HA TIEN
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:HA TIEN
Other - Middle Name:
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1350 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-2912
Mailing Address - Country:US
Mailing Address - Phone:617-265-0728
Mailing Address - Fax:617-265-0931
Practice Address - Street 1:1350 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-2912
Practice Address - Country:US
Practice Address - Phone:617-265-0728
Practice Address - Fax:617-265-0931
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4927152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAML0889470MOtherCONTROLLED SUBSTANCE REGISTRATION NUMBER