Provider Demographics
NPI:1538362470
Name:LEE, OLIVIA AO-LI (MD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:AO-LI
Last Name:LEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 MALLARD LANE
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574-1214
Mailing Address - Country:US
Mailing Address - Phone:512-352-7664
Mailing Address - Fax:512-365-5237
Practice Address - Street 1:603 MALLARD LANE
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:TX
Practice Address - Zip Code:76574-1214
Practice Address - Country:US
Practice Address - Phone:512-352-7664
Practice Address - Fax:512-365-5237
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA60658207W00000X
TXN2168207W00000X
GA060658207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP2-0022424OtherINSTITUTIONAL PERMIT