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General NPI Number Information
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NPI Number | 1053446153
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Entity Type | Organization
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Legal Business Name | DR TODD W LEE O D P C
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5323 E COURT ST N
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City | BURTON
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State | MI
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Zip | 48509-1539
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Country | US
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Telephone | 810-744-9596
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Fax |
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Provider Business Mailing Address
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Address Line | 2227 ANTRIM CT
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City | DAVISON
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State | MI
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Zip | 48423-8439
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TODD W LEE
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Credential | O.D.
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Telephone | 810-744-9596
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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 | 4901003825
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License Number State | MI
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