Basic Information
| Provider Information | |||||||||
| NPI: | 1437358017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | HELEN | ||||||||
| MiddleName: | H.N. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NGUYEN | ||||||||
| OtherFirstName: | THUY-HIEN | ||||||||
| OtherMiddleName: | THI | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | O.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 27 MEMORIAL PKWY | ||||||||
| Address2: | |||||||||
| City: | RANDOLPH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023684539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819867400 | ||||||||
| FaxNumber: | 7819865201 | ||||||||
| Practice Location | |||||||||
| Address1: | 27 MEMORIAL PKWY | ||||||||
| Address2: | |||||||||
| City: | RANDOLPH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023684539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7819867400 | ||||||||
| FaxNumber: | 7819865201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4712 | MA | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | OPT914 | ME | N | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0728241 | 05 | MA | MEDICAID | 1437358017 | 01 | ME | ANTHEM | OTHER | 435949199 | 05 | ME | MEDICAID |