Active NPI
Cuc Kim T Le, O.D.
- Optometrist
- Flower Mound, TX
National Provider Identifier
1124343561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 7923T
- Practice address
- 5959 Long Prairie Road
Flower Mound, TX 75028 - Phone
- (214) 513-8039
- Fax
- (972) 874-6719
- NPI assigned
- Mar 29, 2010
- Last updated
- Oct 15, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046010315 | IL | |
| Optometrist | 152W00000X | 7923T | TX | Primary |
Addresses
Primary practice location
5959 Long Prairie Road
Flower Mound, TX 75028
Mailing address
9529 S Kildare Ave
Oak Lawn, IL 60453-3222
Phone (708) 717-9523
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 579250097 | Other | IL | MEDICARE PTAN |
| 579270084 | Other | IL | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046010315 | IL | MD | Optometrist |
| 7923T | TX | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gel M Gowin,Inc. | Past | Accepting new patients | |
| 95TH Vision Center LLC | Optometrist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Eyewear Supplier
- Evergreen Park, IL
- NPI 1225351471
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1269820800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350259200000",
"number": "1124343561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9529 S KILDARE AVE",
"city": "OAK LAWN",
"state": "IL",
"postal_code": "604533222",
"telephone_number": "708-717-9523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5959 LONG PRAIRIE ROAD",
"city": "FLOWER MOUND",
"state": "TX",
"postal_code": "75028",
"telephone_number": "214-513-8039",
"fax_number": "972-874-6719"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LE",
"first_name": "CUC KIM",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-03-29",
"last_updated": "2012-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046010315",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "TX",
"license": "7923T",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "579250097",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "579270084",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flower Mound, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.