Healthcare Provider Details

I. General information

NPI: 1245227321
Provider Name (Legal Business Name): JASON C LEE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W CHURCH ST
BISHOPVILLE SC
29010-1016
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-8575
US

V. Phone/Fax

Practice location:
  • Phone: 803-484-5494
  • Fax:
Mailing address:
  • Phone: 864-359-1308
  • Fax: 239-496-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1245
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: