Individual provider Active NPI

Kevin Le, OD

  • Optometrist
  • Austin, TX
National Provider Identifier
1740890300
Registry record updated Aug 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
10092 Issued in TX
Practice address
9600 S Interstate 35 Ste S225
Austin, TX 78748-3889
Phone
(512) 291-0876
NPI assigned
Aug 7, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 7, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 10092 TX Primary

Addresses

Primary practice location

9600 S Interstate 35 Ste S225
Austin, TX 78748-3889

Mailing address

9418 Cornett Dr
Houston, TX 77064-7606
Phone (832) 708-6068

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210331000506 TX Practitioner - Optometry 2668889007 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University Alabama Birmingham - School of Optometry
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Berg En Dal PLLCGroup PAC ID 3779682018, 5 clinicians

Practice addresses (Care Compare)

3601 W William Cannon Dr
Suite 150
Austin, TX 78749-1533
Phone (512) 441-8924

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10092TXMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Berg En Dal PLLC Optometrist CurrentSince Mar 29, 2021 Accepting new patients
Elite Vision Group, PLLC Optometrist CurrentSince Jan 25, 2022 Accepting new patients
Berg En Dal PLLC Optometrist CurrentSince Mar 29, 2021 Accepting new patients

Locations

3601 W William Cannon Dr
Ste 150
Austin, TX 78749
Phone (512) 441-8924

2407 S Congress Ave
Ste 100A
Austin, TX 78704
Phone (512) 233-6879

9600 S Interstate 35
Ste S225
Austin, TX 78748
Phone (512) 291-0876

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1596758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596758400000",
    "number": "1740890300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9418 CORNETT DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770647606",
            "telephone_number": "832-708-6068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9600 S INTERSTATE 35 STE S225",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787483889",
            "telephone_number": "512-291-0876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "KEVIN",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-07",
        "last_updated": "2020-08-07",
        "certification_date": "2020-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "10092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.