Provider Demographics
NPI:1386807964
Name:TEA, KELLEE LEANGSOK (OD)
Entity type:Individual
Prefix:
First Name:KELLEE
Middle Name:LEANGSOK
Last Name:TEA
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 1:14361 BEACH BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-8140
Mailing Address - Country:US
Mailing Address - Phone:714-684-1711
Mailing Address - Fax:714-775-7050
Practice Address - Street 1:14361 BEACH BLVD STE 201
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-8140
Practice Address - Country:US
Practice Address - Phone:714-684-1711
Practice Address - Fax:714-684-1920
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002088152W00000X
CA13559TLG152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152W00000XEye and Vision Services ProvidersOptometrist