Provider Demographics
NPI:1548338577
Name:LE, SAMANTHA TRAN (OD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:TRAN
Last Name:LE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:T
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2905 INGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-7632
Mailing Address - Country:US
Mailing Address - Phone:626-627-5932
Mailing Address - Fax:
Practice Address - Street 1:10801 HICKORY RIDGE RD
Practice Address - Street 2:200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3869
Practice Address - Country:US
Practice Address - Phone:140-997-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 1966152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist