Healthcare Provider Details

I. General information

NPI: 1619555315
Provider Name (Legal Business Name): ALICIA LEE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 BOLLINGER CANYON RD STE 2650
SAN RAMON CA
94583-2317
US

IV. Provider business mailing address

6000 BOLLINGER CANYON RD STE 1213
SAN RAMON CA
94583-2306
US

V. Phone/Fax

Practice location:
  • Phone: 646-502-7879
  • Fax:
Mailing address:
  • Phone: 646-502-7879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: