Healthcare Provider Details

I. General information

NPI: 1871644757
Provider Name (Legal Business Name): WILLIAM P LEE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E JULIAN ST
SAN JOSE CA
95112-4007
US

IV. Provider business mailing address

160 E VIRGINIA ST STE 100
SAN JOSE CA
95112-5865
US

V. Phone/Fax

Practice location:
  • Phone: 408-918-2600
  • Fax:
Mailing address:
  • Phone: 408-579-6178
  • Fax: 408-579-6178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: