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General NPI Number Information
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NPI Number | 1558803304
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Entity Type | Organization
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Legal Business Name | LEE VISION FAMILY EYE CLINIC, LLC
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Dates
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Enumeration Date | 11/10/2016
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Last Update Date | 02/26/2018
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Provider Practice Location Address
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Address Line | 2520 WHITE BEAR AVE N SUITE B
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City | MAPLEWOOD
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State | MN
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Zip | 55109-5136
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Country | US
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Telephone | 920-918-6119
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Fax |
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Provider Business Mailing Address
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Address Line | 2520 WHITE BEAR AVE N STE B
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City | MAPLEWOOD
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State | MN
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Zip | 55109-5175
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Country | US
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Telephone | 651-447-2247
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Fax |
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Authorized Official
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Title or Position | DR.
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Name | ALLEN MA LEE
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Credential | O.D.
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Telephone | 651-447-2247
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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 | 3313
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License Number State | MN
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