Individual provider Active NPI

Tracy Bichtram Le, O.D.

  • Optometrist
  • Garden Grove, CA
National Provider Identifier
1295812220
Registry record updated Apr 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9703T Issued in CA
Practice address
9856 Westminster Ave Ste 126
Garden Grove, CA 92844-2907
Phone
(714) 530-0751
Fax
(714) 530-0751
NPI assigned
Nov 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9703T CA Primary

Addresses

Primary practice location

9856 Westminster Ave Ste 126
Garden Grove, CA 92844-2907

Mailing address

9856 Westminster Ave Ste 126
Garden Grove, CA 92844-2907
Phone (714) 530-0751

Other identifiers 1

IdentifierTypeStateIssuer
SD0097030MedicaidCA

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
9703TCAMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335484800000",
    "number": "1295812220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9856 WESTMINSTER AVE STE 126",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928442907",
            "telephone_number": "714-530-0751",
            "fax_number": "714-530-0751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9856 WESTMINSTER AVE STE 126",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928442907",
            "telephone_number": "714-530-0751",
            "fax_number": "714-530-0751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "TRACY",
        "middle_name": "BICHTRAM",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2012-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9703T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0097030",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 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.

Verify at the official NPI Registry.