Healthcare Provider Details

I. General information

NPI: 1932471083
Provider Name (Legal Business Name): LEE EYE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16761 SAINT CLAIR AVE
EAST LIVERPOOL OH
43920-9400
US

IV. Provider business mailing address

8135 MARKET ST
YOUNGSTOWN OH
44512-6244
US

V. Phone/Fax

Practice location:
  • Phone: 330-382-0573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY MAE HORNE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 330-758-0900