Physician Compare National (NPI:1215120696)

HEALTHCARE PROVIDER: LEE BROCK WREN OD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1215120696
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7315025582
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110121000881
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WREN
	Individual professional last name
Provider First Name	LEE
	Individual professional first name
Provider Middle Name	B
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	PACIFIC UNIVERSITY - COLLEGE OF OPTOMETRY
	Individual professional's medical school
Graduation Year	2007
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	715 W JUDICIAL ST
	Group Practice or individual's line 1 address
City	BLACKFOOT
	Group Practice or individual's city
State	ID
	Group Practice or individual's state
Zip Code	832212036
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y