Provider Demographics
NPI:1316936792
Name:LE, MINH NHAT VU (OPTOMETRIST)
Entity type:Individual
Prefix:DR
First Name:MINH NHAT
Middle Name:VU
Last Name:LE
Suffix:
Gender:M
Credentials:OPTOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 E CAPITOL EXPY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1839
Mailing Address - Country:US
Mailing Address - Phone:408-528-0991
Mailing Address - Fax:408-528-0994
Practice Address - Street 1:1652 E CAPITOL EXPY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1839
Practice Address - Country:US
Practice Address - Phone:408-528-0991
Practice Address - Fax:408-528-0994
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11843T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACD605ZOtherMEDICARE PTAN
CACD605ZOtherMEDICARE PTAN