Basic Information
| Provider Information | |||||||||
| NPI: | 1912907429 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | CONSTANCE | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 940 COMMONWEALTH AVE SUITE 2 | ||||||||
| Address2: | NEW ENGLAND EYE INSTITUTE | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172622020 | ||||||||
| FaxNumber: | 6172366323 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 COMMONWEALTH AVE | ||||||||
| Address2: | #2A | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022151274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172622020 | ||||||||
| FaxNumber: | 6172366323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 03/18/2009 | ||||||||
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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 | 4100 | MA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | W16249 | 01 | MA | BCBS | OTHER | 30548 | 01 | MA | BMC | OTHER | 31511 | 01 | MA | NHP | OTHER | MA4400 | 01 | MA | EYEMED | OTHER | 976490 | 01 | MA | NETWORK HEALTH | OTHER | AA20532 | 01 | MA | HARVARD PILGRIM | OTHER | 334651 | 05 | MA | MEDICAID | 2077157 | 01 | MA | UNITED HEALTH CARE | OTHER | 0334651 | 01 | MA | MASS HEALTH | OTHER |