MEDICARE: DR. EMMA ANNE 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	5418TG	TX

General Provider Information

NPI Number	:	1538215504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMMA ANNE LEE O.D.

Provider Business Mailing Address
First Line	:	10411 W FAIRMONT PKWY
Second Line	:
City	:	LA PORTE
State	:	TX
Zip	:	77571-6014
Country	:	US
Telephone Number	:	281-991-6774
Fax Number	:	832-201-9836

Provider Business Practice Location Address
First Line	:	10411 W FAIRMONT PKWY
Second Line	:
City	:	LA PORTE
State	:	TX
Zip	:	77571-6014
Country	:	US
Telephone Number	:	281-991-6774
Fax Number	:	832-201-9836

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	04/18/2014

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