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General NPI Number Information
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NPI Number | 1386165249
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Entity Type | Organization
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Legal Business Name | DR. ANGELA DEANN LEE ,INC
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1005 POWERS PL
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City | ALPHARETTA
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State | GA
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Zip | 30009-8356
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Country | US
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Telephone | 770-712-9125
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Fax |
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Provider Business Mailing Address
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Address Line | 959 BRIDGEGATE DR NE
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City | MARIETTA
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State | GA
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Zip | 30068-2206
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Country | US
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Telephone | 770-712-9125
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. ANGELA DEANN LEE
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Credential | OD
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Telephone | 770-712-9125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 1284
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1284
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1284
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License Number State | GA
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