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General NPI Number Information
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NPI Number | 1578709853
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Entity Type | Organization
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Legal Business Name | DOUGLAS D LEE OD LTD
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 1627 NEVADA HWY
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City | BOULDER CITY
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State | NV
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Zip | 89005-1908
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Country | US
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Telephone | 702-294-2227
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Fax | 702-293-3723
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Provider Business Mailing Address
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Address Line | 1627 NEVADA HWY
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City | BOULDER CITY
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State | NV
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Zip | 89005-1908
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Country | US
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Telephone | 702-294-2227
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Fax | 702-293-3723
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Authorized Official
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Title or Position | OWNER
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Name | DOUGLAS DAVID LEE
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Credential | OD
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Telephone | 702-294-2227
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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 | NV234
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License Number State | NV
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