MEDICARE: SARAH LEE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	13537	CA

General Provider Information

NPI Number	:	1164650701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LEE O.D.

Provider Business Mailing Address
First Line	:	330 VIA LAS BRISAS
Second Line	:	UNIT 140
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-7038
Country	:	US
Telephone Number	:	805-498-7209
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 VIA LAS BRISAS
Second Line	:	UNIT 140
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-7038
Country	:	US
Telephone Number	:	805-498-7209
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	08/16/2016

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