Provider Demographics
NPI:1306958566
Name:LEE, BARBARA J (OD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17780 ARROWHEAD TOWN CENTER
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:602-759-0540
Mailing Address - Fax:
Practice Address - Street 1:10001 N METRO PKWY W
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1405
Practice Address - Country:US
Practice Address - Phone:602-759-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ880152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0902320OtherBLUE CROSS BLUE SHIELD
AZAZ0902320OtherBLUE CROSS BLUE SHIELD
AZU4368Medicare UPIN
AZZ70113Medicare PIN
AZ4961130001Medicare NSC