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General NPI Number Information
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NPI Number | 1013909555
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Entity Type | Individual
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Provider Name | ROBERT FREDRICK LEE III O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 15157 GRATIOT AVE
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City | DETROIT
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State | MI
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Zip | 48205-1324
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Country | US
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Telephone | 313-526-7664
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Fax | 313-526-2055
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Provider Business Mailing Address
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Address Line | 15157 GRATIOT AVE
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City | DETROIT
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State | MI
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Zip | 48205-1324
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Country | US
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Telephone | 313-526-7664
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Fax | 313-526-2055
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003122
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License Number State | MI
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