Provider Demographics
NPI:1194797001
Name:LERNER, LEE DAVID (OD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:DAVID
Last Name:LERNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 MOODY ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-5208
Mailing Address - Country:US
Mailing Address - Phone:781-894-1094
Mailing Address - Fax:781-894-0210
Practice Address - Street 1:381 MOODY ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-5208
Practice Address - Country:US
Practice Address - Phone:781-894-1094
Practice Address - Fax:781-894-0210
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3526152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW16225OtherBLUE CROSS BLUE SHIELD
MA0356425Medicaid
MA112137OtherEYEMED
MA28445OtherAETNA
MA722336OtherTUFTS
MA152101OtherHARVARD PILGRIM HEALTHCAR
MA2200464OtherUNITED HEALTHCARE
MA451558Medicare ID - Type Unspecified