Provider Demographics
NPI:1285111641
Name:LE, CASSIE MARIE (OD)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:MARIE
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 1:17945 HUNTING BOW CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5376
Mailing Address - Country:US
Mailing Address - Phone:727-873-0944
Mailing Address - Fax:
Practice Address - Street 1:8549 N ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-1521
Practice Address - Country:US
Practice Address - Phone:405-720-8316
Practice Address - Fax:405-421-0944
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2990152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist