Provider Demographics
NPI:1386165249
Name:DR. ANGELA DEANN LEE ,INC
Entity type:Organization
Organization Name:DR. ANGELA DEANN LEE ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DEANN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:770-712-9125
Mailing Address - Street 1:959 BRIDGEGATE DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2206
Mailing Address - Country:US
Mailing Address - Phone:770-712-9125
Mailing Address - Fax:
Practice Address - Street 1:1005 POWERS PL
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-8356
Practice Address - Country:US
Practice Address - Phone:770-712-9125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. ANGELA D LEE OD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1284152W00000X, 152WC0802X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty