Provider Demographics
NPI:1902152473
Name:LE, THANH (OD)
Entity type:Individual
Prefix:
First Name:THANH
Middle Name:
Last Name:LE
Suffix:
Gender:
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:PO BOX 630147
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80163-0147
Mailing Address - Country:US
Mailing Address - Phone:708-833-0711
Mailing Address - Fax:
Practice Address - Street 1:1265 SGT JON STILES DR
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2263
Practice Address - Country:US
Practice Address - Phone:303-791-1984
Practice Address - Fax:303-683-5560
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003476152W00000X
CA14586152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COOPT.0003476OtherCO OPTOMETRY LICENSE