Provider Demographics
NPI:1902089881
Name:JEFFREY B. LEE O.D.
Entity Type:Organization
Organization Name:JEFFREY B. LEE O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:209-384-2335
Mailing Address - Street 1:708 W 20TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-3639
Mailing Address - Country:US
Mailing Address - Phone:209-384-2335
Mailing Address - Fax:209-384-2342
Practice Address - Street 1:708 W 20TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-3639
Practice Address - Country:US
Practice Address - Phone:209-384-2335
Practice Address - Fax:209-384-2342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5423T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ39234ZMedicare PIN