Healthcare Provider Details

I. General information

NPI: 1821047515
Provider Name (Legal Business Name): CHAN LEE WEBSTER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

IV. Provider business mailing address

2766 HARNEY PATH PMB 307
JBSA FSH TX
78234
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-9588
  • Fax: 210-539-2086
Mailing address:
  • Phone: 210-683-3001
  • Fax: 210-539-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTN1741
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1741
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: