MEDICARE: MATTHEW LEE

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	34915	CA

General Provider Information

NPI Number	:	1467128173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW LEE

Provider Business Mailing Address
First Line	:	33733 TRAILSIDE WAY
Second Line	:
City	:	UNION CITY
State	:	CA
Zip	:	94587-4369
Country	:	US
Telephone Number	:	510-386-6863
Fax Number	:

Provider Business Practice Location Address
First Line	:	34420 FREMONT BLVD STE E
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94555-3323
Country	:	US
Telephone Number	:	510-796-9600
Fax Number	:

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

Provider Enumeration Date	:	08/22/2021
Last Update Date	:	08/22/2021

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Directions to “ MATTHEW LEE ” Practice Location

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