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General NPI Number Information
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NPI Number | 1649461674
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Entity Type | Individual
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Provider Name | AMANDA M. LEE O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 07/29/2015
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Provider Practice Location Address
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Address Line | 4001 2ND AVE W
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City | WILLISTON
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State | ND
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Zip | 58801-2603
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Country | US
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Telephone | 701-577-2020
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Fax | 701-577-2021
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Provider Business Mailing Address
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Address Line | 4001 2ND AVE W
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City | WILLISTON
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State | ND
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Zip | 58801-2603
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Country | US
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Telephone | 701-577-2020
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Fax | 701-577-2021
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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 | 654
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License Number State | ND
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