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General NPI Number Information
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NPI Number | 1093215949
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Entity Type | Organization
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Legal Business Name | SUSANNAH LEE EYE CARE
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Dates
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Enumeration Date | 02/16/2018
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 5295 NE ELAM YOUNG PKWY STE 150
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City | HILLSBORO
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State | OR
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Zip | 97124-7572
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Country | US
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Telephone | 503-547-8201
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Fax | 503-547-8288
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Provider Business Mailing Address
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Address Line | 1830 NW RIVERSCAPE ST APT 504
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City | PORTLAND
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State | OR
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Zip | 97209-1840
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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 | SUSANNAH LEE
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Credential | O.D.
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Telephone | 971-506-6880
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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 |
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License Number State |
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