Doctor Name: | JAE LEE |
NPI Number: | 1013214287 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | LDO002349 |
Business Practice Address: | 1630 Pleasant Hill Rd #b11 Duluth, GA - 30096 |
Business Phone Number: | 6788942161 |
Business Fax Number: | 6788236923 |
Mailing Address: | 3624 Dunbar Ln, SUWANEE |
State: | GA |
Postal Code: | 300247411 |
Phone Number: | 6789071587 |
Fax Number: | 6788236923 |
NPI Enumeration Date: | 02/23/2011 |
NPI Last Update Date: | 02/23/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | LDO002349 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |