MEDICARE: DR. ANNE CINDY LEE OD, FAAO

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	152WP0200X	Pediatric Optometrist	13467	CA
2	152W00000X	Optometrist	1324	AZ
3	152W00000X	Optometrist	13467	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11423229	OTHER		CAQH UNIVERSAL CREDENTIAL

General Provider Information

NPI Number	:	1366440018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE CINDY LEE OD, FAAO

Provider Business Mailing Address
First Line	:	1828 WALNUT AVE
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5019
Country	:	US
Telephone Number	:	917-554-5336
Fax Number	:

Provider Business Practice Location Address
First Line	:	13427 INGLEWOOD AVE
Second Line	:
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-5608
Country	:	US
Telephone Number	:	310-676-2020
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	05/26/2022

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