=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578703146
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR TODD W LEE & ASSOCIATES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2009
-----------------------------------------------------
Last Update Date | 02/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5323 E COURT ST N
-----------------------------------------------------
City | BURTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48509-1539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-744-9596
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2227 ANTRIM CT
-----------------------------------------------------
City | DAVISON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48423-8439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-744-9596
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TODD W LEE
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 810-744-9596
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4901003825
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------