| Organization Name: | GLORIA LEE DBA |
| NPI Number: | 1124146071 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GLORIA ANN LEE (OWNER/OPTICIAN) |
| Mailing Address: | 192 Lafayette St Ringgold |
| State: | GA US |
| Postal Code: | 307362431 |
| Phone Number: | 7069652020 |
| Fax Number: | 7069652020 |
| NPI Enumeration Date: | 03/27/2007 |
| NPI Last Update Date: | 04/15/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | LDO000851 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |