Provider Demographics
NPI:1528291267
Name:LEE, ROBERT KEN (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:KEN
Last Name:LEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 SAN ANTONIO RD
Mailing Address - Street 2:APT 56
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4816
Mailing Address - Country:US
Mailing Address - Phone:650-814-2278
Mailing Address - Fax:
Practice Address - Street 1:1040B EAST IMPERIAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821
Practice Address - Country:US
Practice Address - Phone:714-990-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13811152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist