Provider Demographics
NPI:1104231646
Name:LE, ANNIE DIEM HANG NGOC (OD)
Entity type:Individual
Prefix:MS
First Name:ANNIE DIEM HANG
Middle Name:NGOC
Last Name:LE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2873 39TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-4009
Mailing Address - Country:US
Mailing Address - Phone:619-565-7102
Mailing Address - Fax:
Practice Address - Street 1:2873 39TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-4009
Practice Address - Country:US
Practice Address - Phone:619-565-7102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 14917 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist