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NPI Code Detail

MEDICARE: LEANNE LEE O.D.

MEDICARE:   LEANNE  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
1152WP0200XPediatric Optometrist12388TCA

General Provider Information

NPI Number : 1982704979
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEANNE LEE O.D.
Provider Business Mailing Address
First Line : 2433 BROADRIDGE WAY
Second Line :
City : STOCKTON
State : CA
Zip : 95209-1246
Country : US
Telephone Number : 209-477-3888
Fax Number :
Provider Business Practice Location Address
First Line : 2321 W MARCH LN
Second Line : STE A
City : STOCKTON
State : CA
Zip : 95207-5261
Country : US
Telephone Number : 209-957-8000
Fax Number : 209-957-8077
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2006
Last Update Date : 07/26/2016

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