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General NPI Number Information
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NPI Number | 1245545102
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Entity Type | Individual
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Provider Name | MIRIAM LEE O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/16/2010
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 11915 ATLANTIC AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11418-3216
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Country | US
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Telephone | 718-805-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 184 HARRIS AVE
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City | HEWLETT
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State | NY
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Zip | 11557-1319
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Country | US
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Telephone | 516-374-5662
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Fax |
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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 | 007618
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License Number State | NY
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