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General NPI Number Information
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NPI Number | 1760656417
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Entity Type | Organization
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Legal Business Name | GARY LEE OD
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 10614 LOWER AZUSA RD
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City | EL MONTE
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State | CA
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Zip | 91731-1210
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Country | US
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Telephone | 626-442-6620
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Fax | 626-442-5803
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Provider Business Mailing Address
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Address Line | 10614 LOWER AZUSA RD
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City | EL MONTE
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State | CA
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Zip | 91731-1210
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Country | US
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Telephone | 626-442-6620
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Fax | 626-442-5803
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MR. GARY A LEE
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Credential | O.D.
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Telephone | 626-442-6620
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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 | OP5893T
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License Number State | CA
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