Basic Information
| Provider Information | |||||||||
| NPI: | 1215379169 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | SUNG HEE | ||||||||
| MiddleName: | |||||||||
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| Credential: | O.D | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LEE | ||||||||
| OtherFirstName: | KELLY | ||||||||
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| OtherCredential: | O.D | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2043 COLLEGE WAY | ||||||||
| Address2: | |||||||||
| City: | FOREST GROVE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971161756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033526151 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2043 COLLEGE WAY | ||||||||
| Address2: | |||||||||
| City: | FOREST GROVE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971161756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033526151 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2013 | ||||||||
| LastUpdateDate: | 07/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3514AT | OR | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.