Provider Demographics
NPI:1386701597
Name:LEE DAO INC
Entity type:Organization
Organization Name:LEE DAO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-354-4030
Mailing Address - Street 1:9265 E BASELINE RD
Mailing Address - Street 2:STE. 102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-8312
Mailing Address - Country:US
Mailing Address - Phone:480-354-4030
Mailing Address - Fax:480-354-4492
Practice Address - Street 1:9265 E BASELINE RD
Practice Address - Street 2:STE. 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-8312
Practice Address - Country:US
Practice Address - Phone:480-354-4030
Practice Address - Fax:480-354-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1134152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ74488OtherPTAN
AZ1386701597OtherNPI
AZ1386701597OtherNPI