Doctor Name: | MRS. GLORIA ANN LEE |
NPI Number: | 1407026404 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | OPTICIAN/OWNER |
License Number: | |
Business Practice Address: | 3030 Lafayette Rd Fort Oglethorpe, GA - 307423782 |
Business Phone Number: | 7068662247 |
Business Fax Number: | 7068662247 |
Mailing Address: | 3030 Lafayette Rd, FORT OGLETHORPE |
State: | GA |
Postal Code: | 307423782 |
Phone Number: | 7068615915 |
Fax Number: | 7068662247 |
NPI Enumeration Date: | 03/05/2008 |
NPI Last Update Date: | 03/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |