Provider Demographics
NPI:1316069479
Name:LEE, RIA (OD)
Entity type:Individual
Prefix:DR
First Name:RIA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2 W TALCOTT RD
Mailing Address - Street 2:SUITE 30
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5556
Mailing Address - Country:US
Mailing Address - Phone:847-696-2434
Mailing Address - Fax:847-696-1481
Practice Address - Street 1:2 W TALCOTT RD
Practice Address - Street 2:SUITE 30
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5556
Practice Address - Country:US
Practice Address - Phone:847-696-2434
Practice Address - Fax:847-696-1481
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL046009752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist