MEDICARE: DR. NICOLE STEPHANIE 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	OPT.0004152	CO
2	152W00000X	Optometrist	TPOP306	FL
3	152W00000X	Optometrist	10506	TX
4	152W00000X	Optometrist	VI61	VI

General Provider Information

NPI Number	:	1780051763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE STEPHANIE LEE O.D.

Provider Business Mailing Address
First Line	:	2007 S 1ST ST STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-5195
Country	:	US
Telephone Number	:	512-774-6002
Fax Number	:	512-774-5975

Provider Business Practice Location Address
First Line	:	2007 S 1ST ST STE 104
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-5195
Country	:	US
Telephone Number	:	512-774-6002
Fax Number	:	512-774-5975

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

Provider Enumeration Date	:	08/26/2015
Last Update Date	:	12/16/2025

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