MEDICARE: DENNIS LEE OD

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	3561TX	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588849798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS LEE OD

Provider Business Mailing Address
First Line	:	1115 R ST NW
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98001-3848
Country	:	US
Telephone Number	:	253-333-0054
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 AUBURN WAY N STE B
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98002-4164
Country	:	US
Telephone Number	:	253-735-4732
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/07/2008

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Directions to “ DENNIS LEE OD” Practice Location

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