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General NPI Number Information
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NPI Number | 1205166386
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Entity Type | Individual
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Provider Name | PETER B LEE O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 4518 186TH ST #110
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City | REDONDO BEACH
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State | CA
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Zip | 90278-4669
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Country | US
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Telephone | 315-725-3601
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Fax | 315-725-5442
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Provider Business Mailing Address
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Address Line | BOX NUMBER 558 121 COMBAT SUPPORT HOSPITAL
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City | APO
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State | AP
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Zip | 96205-5244
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Country | US
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Telephone | 315-725-3601
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Fax | 315-725-5442
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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 | 10116
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License Number State | CA
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