Provider Demographics
NPI:1528506698
Name:LE, PATRICIA (OD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
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 1:2330 WARRING ST
Mailing Address - Street 2:APT #122
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1803
Mailing Address - Country:US
Mailing Address - Phone:951-660-7699
Mailing Address - Fax:
Practice Address - Street 1:6500 FAIRMOUNT AVE
Practice Address - Street 2:STE 2
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3667
Practice Address - Country:US
Practice Address - Phone:888-690-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist