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General NPI Number Information
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NPI Number | 1285745604
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Entity Type | Individual
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Provider Name | CHANG SOO DANIEL LEE O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 700 LAFAYETTE RD UNIT 1
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City | SEABROOK
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State | NH
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Zip | 03874-6202
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Country | US
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Telephone | 603-474-1681
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Fax | 603-474-0695
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Provider Business Mailing Address
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Address Line | 700 LAFAYETTE RD
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City | SEABROOK
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State | NH
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Zip | 03874-6202
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Country | US
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Telephone | 603-474-1681
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Fax | 603-474-0695
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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 | 0728
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4207
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License Number State | MA
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