Provider Demographics
NPI:1851355309
Name:LEE, EILEEN S (OD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:EILEEN
Other - Middle Name:S
Other - Last Name:LO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:515 CREEDON CIR
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-7795
Mailing Address - Country:US
Mailing Address - Phone:510-839-0938
Mailing Address - Fax:510-839-1818
Practice Address - Street 1:388 9TH ST STE 157
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4290
Practice Address - Country:US
Practice Address - Phone:510-268-9600
Practice Address - Fax:510-268-1608
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8533T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0504000002OtherMEDICARE NSC
CASD0085331Medicaid
CASD0085330Medicaid
CASD0085332Medicaid
CA0504000001Medicare NSC
CASD0085332Medicare PIN
CASD0085330Medicare PIN
CAU12646Medicare UPIN