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General NPI Number Information
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NPI Number | 1346696812
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Entity Type | Organization
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Legal Business Name | DR. PALMER N. LEE, OD INC
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 421 BLUE RAVINE RD STE 300
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City | FOLSOM
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State | CA
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Zip | 95630-3821
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Country | US
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Telephone | 916-983-1066
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Fax | 916-984-6922
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Provider Business Mailing Address
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Address Line | 421 BLUE RAVINE RD STE 300
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City | FOLSOM
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State | CA
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Zip | 95630-3821
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Country | US
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Telephone | 916-983-1066
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Fax | 916-984-6922
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Authorized Official
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Title or Position | OWNER
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Name | PALMER N LEE
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Credential | OD
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Telephone | 916-983-1066
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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 | OPT5895TPL
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License Number State | CA
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