Mimi Ngoc Bao Le, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

6783T Issued in TX

Practice address

4901 S Broadway Ave
Tyler, TX 75703-1325

Phone

(903) 508-2498

Fax

(903) 508-2500

NPI assigned

Jan 17, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Mimi Ngocbao Le Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1073593000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 CARRIAGE DRIVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "75703",
            "telephone_number": "903-316-2092",
            "fax_number": "903-508-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 S BROADWAY AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031325",
            "telephone_number": "903-508-2498",
            "fax_number": "903-508-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "MIMI NGOC BAO",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-01-17",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "6783T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "181592001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIMI",
            "last_name": "LE",
            "middle_name": "NGOCBAO",
            "prefix": "DR.",
            "credential": "OD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jason D Layne, PA-C
• Sheila Renee Layne, DO
• Cynthia Lazear
• Dan Thien Le, MD
• Michael Le, MD
• Minh Q Le, MD
• Quoc-Albert D Le, DDS
• Kaitlyn League, AUD
• Haley E Leake
• Leann Cargile , Otr, LLC

• Optometrist in Tyler, TX
• Providers in Tyler, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.