MEDICARE: DR. CAROL 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	WA1786	WA

General Provider Information

NPI Number	:	1780766915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL LEE O.D.

Provider Business Mailing Address
First Line	:	13030 121ST WAY NE
Second Line	:	SUITE 101
City	:	KIRKLAND
State	:	WA
Zip	:	98034-3008
Country	:	US
Telephone Number	:	425-823-1700
Fax Number	:	425-823-1717

Provider Business Practice Location Address
First Line	:	13030 121ST WAY NE
Second Line	:	SUITE 101
City	:	KIRKLAND
State	:	WA
Zip	:	98034-3008
Country	:	US
Telephone Number	:	425-823-1700
Fax Number	:	425-823-1717

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. CAROL LEE O.D.” Practice Location

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