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General NPI Number Information
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NPI Number | 1679661250
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Entity Type | Individual
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Provider Name | PERRY K LEE OD
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 1051 A PARK DR.
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City | GREENSBORO
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State | GA
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Zip | 30642-3465
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Country | US
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Telephone | 706-453-4535
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Fax | 706-453-4539
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Provider Business Mailing Address
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Address Line | 1051 A PARK DR
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City | GREENSBORO
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State | GA
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Zip | 30642-3465
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Country | US
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Telephone | 706-453-4535
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Fax | 706-453-4539
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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 | GA1558
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License Number State | GA
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