Provider Demographics
NPI:1699878991
Name:LE, JENNIFER N (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:N
Last Name:LE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:N
Other - Last Name:BUI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2722 ABORN RD.
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1204
Mailing Address - Country:US
Mailing Address - Phone:408-223-2020
Mailing Address - Fax:408-531-1987
Practice Address - Street 1:2722 ABORN RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1204
Practice Address - Country:US
Practice Address - Phone:408-223-2020
Practice Address - Fax:408-531-1987
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10087152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0100870Medicaid
CI078ZMedicare PIN