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General NPI Number Information
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NPI Number | 1578932463
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Entity Type | Individual
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Provider Name | SAM LEE O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2015
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Last Update Date | 02/05/2023
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Provider Practice Location Address
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Address Line | 601 ROUTE 206 UNIT 36
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-1522
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Country | US
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Telephone | 908-359-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 601 ROUTE 206 UNIT 36
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-1522
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Country | US
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Telephone |
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Fax |
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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 | 56 008337
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00663500
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License Number State | NJ
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