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General NPI Number Information
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NPI Number | 1891013819
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Entity Type | Individual
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Provider Name | MICHAEL LEE O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2010
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 2366 EL CAMINO REAL STE 5
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City | SANTA CLARA
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State | CA
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Zip | 95050-4070
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Country | US
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Telephone | 408-246-5858
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Fax |
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Provider Business Mailing Address
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Address Line | 800 S ABEL ST UNIT 305
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City | MILPITAS
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State | CA
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Zip | 95035-8697
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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 | 13608T
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License Number State | CA
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