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General NPI Number Information
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NPI Number | 1366593873
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Entity Type | Individual
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Provider Name | ANISSA KIM LEE O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7601 STONERIDGE DR
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City | PLEASANTON
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State | CA
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Zip | 94588-4501
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Country | US
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Telephone | 925-847-5734
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Fax |
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Provider Business Mailing Address
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Address Line | 9643 CAMASSIA WAY
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City | SAN RAMON
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State | CA
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Zip | 94582-5263
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Country | US
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Telephone | 925-648-7988
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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 | 11672T
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License Number State | CA
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