MEDICARE: DR. SUSAN STOWERS LEE O.D.

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	GA1465	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410045041	OTHER	GA	RAILROAD MEDICARE

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	:	1801956503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN STOWERS LEE O.D.

Provider Business Mailing Address
First Line	:	1051 A PARK DR.
Second Line	:
City	:	GREENSBORO
State	:	GA
Zip	:	30642-3465
Country	:	US
Telephone Number	:	706-453-4535
Fax Number	:	706-453-4539

Provider Business Practice Location Address
First Line	:	1051 A PARK DR.
Second Line	:
City	:	GREENSBORO
State	:	GA
Zip	:	30642-3465
Country	:	US
Telephone Number	:	706-453-4535
Fax Number	:	706-453-4539

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	10/07/2008

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