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General NPI Number Information
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NPI Number | 1932592763
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Entity Type | Individual
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Provider Name | CHARLES S LEE O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 9000 MING AVE SUITE L1B
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City | BAKERSFIELD
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State | CA
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Zip | 93311-1318
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Country | US
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Telephone | 661-664-3314
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 MONDAVI WAY UNIT B4
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City | BAKERSFIELD
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State | CA
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Zip | 93312-4346
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Country | US
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Telephone | 323-717-6046
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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 | 15373
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License Number State | CA
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