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General NPI Number Information
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NPI Number | 1427180553
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Entity Type | Individual
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Provider Name | SHERYL WATSON LEE O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 960 BROOKWAY BLVD
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City | BROOKHAVEN
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State | MS
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Zip | 39601-2644
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Country | US
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Telephone | 601-823-4494
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Fax | 601-823-4551
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Provider Business Mailing Address
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Address Line | 6844 HIGHWAY 43
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City | AMITE
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State | LA
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Zip | 70422-8232
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Country | US
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Telephone | 601-823-4494
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Fax | 601-823-4551
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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 | 587-94115
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License Number State | MS
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