Basic Information
| Provider Information | |||||||||
| NPI: | 1275510927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | Q | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1061 C ST STE 140 | ||||||||
| Address2: | |||||||||
| City: | GALT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956321768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2097307477 | ||||||||
| FaxNumber: | 2093346557 | ||||||||
| Practice Location | |||||||||
| Address1: | 1061 C ST STE 140 | ||||||||
| Address2: | |||||||||
| City: | GALT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956321768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2097307477 | ||||||||
| FaxNumber: | 2093346557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2005 | ||||||||
| LastUpdateDate: | 08/16/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 12393T | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.