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General NPI Number Information
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NPI Number | 1184786683
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Entity Type | Organization
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Legal Business Name | PERRY K LEE OD PC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 1051 A PARK DR.
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City | GREENSBORO
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State | GA
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Zip | 30642-3465
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Country | US
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Telephone | 706-453-4535
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Fax | 706-453-4539
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Provider Business Mailing Address
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Address Line | 1051 A PARK DR.
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City | GREENSBORO
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State | GA
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Zip | 30642-3465
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Country | US
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Telephone | 706-453-4535
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Fax | 706-453-4539
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SUSAN STOWERS LEE
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Credential | O.D.
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Telephone | 706-453-4535
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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 | 1558
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License Number State | GA
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