Basic Information
| Provider Information | |||||||||
| NPI: | 1801915368 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | TUAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 CONCORD ST | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926262808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143188477 | ||||||||
| FaxNumber: | 9512797375 | ||||||||
| Practice Location | |||||||||
| Address1: | 479 N MCKINLEY ST | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928791205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512720788 | ||||||||
| FaxNumber: | 9512797375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 12770 | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.