Basic Information
| Provider Information | |||||||||
| NPI: | 1316069479 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | RIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 W TALCOTT RD | ||||||||
| Address2: | SUITE 30 | ||||||||
| City: | PARK RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600685556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476962434 | ||||||||
| FaxNumber: | 8476961481 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 W TALCOTT RD | ||||||||
| Address2: | SUITE 30 | ||||||||
| City: | PARK RIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600685556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476962434 | ||||||||
| FaxNumber: | 8476961481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 046009752 | IL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.