MEDICARE: DR ROBERT F LEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901003122	MI

General Provider Information

NPI Number	:	1346402856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR ROBERT F LEE

Provider Business Mailing Address
First Line	:	15157 GRATIOT AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-1324
Country	:	US
Telephone Number	:	313-526-7664
Fax Number	:	313-526-2055

Provider Business Practice Location Address
First Line	:	15157 GRATIOT AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-1324
Country	:	US
Telephone Number	:	313-526-7664
Fax Number	:	313-526-2055

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT F LEE
Credential	:
Telephone Number	:	313-526-7664

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	11/04/2008

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