Provider Demographics
NPI:1386988111
Name:BRIAN LEE, O.D. PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:BRIAN LEE, O.D. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-570-8800
Mailing Address - Street 1:500 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-3870
Mailing Address - Country:US
Mailing Address - Phone:626-570-8800
Mailing Address - Fax:626-570-8892
Practice Address - Street 1:500 S ATLANTIC BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-3870
Practice Address - Country:US
Practice Address - Phone:626-570-8800
Practice Address - Fax:626-570-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13813TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHI143AMedicare PIN