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General NPI Number Information
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NPI Number | 1669502308
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Entity Type | Individual
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Provider Name | CHUNG HEE LEE OD
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Gender | Male
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 786 BROAD ST
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City | NEWARK
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State | NJ
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Zip | 07102-3728
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Country | US
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Telephone | 973-642-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 63 VAN HOLTEN RD
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City | BASKING RIDGE
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State | NJ
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Zip | 07920-3438
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Country | US
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Telephone | 908-350-3234
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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 | OA 05329
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License Number State | NJ
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