MEDICARE: DR. CHANG SOO DANIEL 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	0728	NH
2	152W00000X	Optometrist	4207	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7572613	OTHER		AETNA
2	8966242/67520	OTHER		CIGNA HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	904088	OTHER		BLOCK VISION
6	18326	OTHER		SPECTERA
7	27509	OTHER		MEDICAL EYE SERVICE
8	09Y004672NH01	OTHER	NH	BLUE CROSS BLUE SHIELD
9	207444	OTHER		COLE VISION
10	AA49702	OTHER	MA	HARVARD PILGRIM
11	23210	OTHER		AVESIS
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	300042	OTHER		NATIONAL VISION ADM
14	48514	OTHER		DAVIS VISION

General Provider Information

NPI Number	:	1285745604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHANG SOO DANIEL LEE O.D.

Provider Business Mailing Address
First Line	:	700 LAFAYETTE RD
Second Line	:
City	:	SEABROOK
State	:	NH
Zip	:	03874-6202
Country	:	US
Telephone Number	:	603-474-1681
Fax Number	:	603-474-0695

Provider Business Practice Location Address
First Line	:	700 LAFAYETTE RD
Second Line	:	UNIT 1
City	:	SEABROOK
State	:	NH
Zip	:	03874-6202
Country	:	US
Telephone Number	:	603-474-1681
Fax Number	:	603-474-0695

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/04/2016

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