Provider Demographics
NPI:1316163371
Name:WILLIAM E. LEE, OD, INC.
Entity type:Organization
Organization Name:WILLIAM E. LEE, OD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WESTON
Authorized Official - Last Name:DICK
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:918-336-0607
Mailing Address - Street 1:311 SE DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-3631
Mailing Address - Country:US
Mailing Address - Phone:918-336-0607
Mailing Address - Fax:918-337-9163
Practice Address - Street 1:311 SE DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-3631
Practice Address - Country:US
Practice Address - Phone:918-336-0607
Practice Address - Fax:918-337-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5320Medicare PIN