Doctor Name: | MARY LEE |
NPI Number: | 1003029752 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | NY5166 |
Business Practice Address: | 902 Main St Buffalo, NY - 142021403 |
Business Phone Number: | 7168839550 |
Business Fax Number: | |
Mailing Address: | 366 Evergreen Dr, TONAWANDA |
State: | NY |
Postal Code: | 141506406 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 05/08/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | NY5166 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |