Provider Demographics
NPI:1861477267
Name:LE, LANCE (OD)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 LUCKENBACH LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063
Mailing Address - Country:US
Mailing Address - Phone:214-228-4108
Mailing Address - Fax:972-663-3938
Practice Address - Street 1:14999 PRESTON RD
Practice Address - Street 2:SUITE 220 D
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-9116
Practice Address - Country:US
Practice Address - Phone:972-663-3937
Practice Address - Fax:972-663-3938
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6124T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150611501Medicaid
TXU89144Medicare UPIN
TX150611501Medicaid