Healthcare Provider Details

I. General information

NPI: 1215854187
Provider Name (Legal Business Name): KAITLYN PAIGE LEE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 42ND ST
NEW YORK NY
10036-8005
US

IV. Provider business mailing address

33 W 42ND ST RM 1102
NEW YORK NY
10036-8005
US

V. Phone/Fax

Practice location:
  • Phone: 626-485-8527
  • Fax:
Mailing address:
  • Phone: 626-485-8527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36341
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011461
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: