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General NPI Number Information
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NPI Number | 1376869354
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Entity Type | Organization
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Legal Business Name | R ALAN LEE OD PC
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 05/05/2010
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Provider Practice Location Address
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Address Line | 43 W WHITE MOUNTAIN BLVD
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City | PINETOP
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State | AZ
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Zip | 85935
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Country | US
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Telephone | 928-367-3967
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1370
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City | PINETOP
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State | AZ
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Zip | 85935-1370
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Country | US
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Telephone | 928-367-3967
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Fax | 928-367-3136
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RALPH ALAN LEE
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Credential | O.D.
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Telephone | 928-367-3967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | AZ
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