Provider Demographics
NPI:1932257037
Name:LEE, SUSIE MEI FUN (OD)
Entity type:Individual
Prefix:DR
First Name:SUSIE
Middle Name:MEI FUN
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:228 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4015
Mailing Address - Country:US
Mailing Address - Phone:650-343-0549
Mailing Address - Fax:650-343-1653
Practice Address - Street 1:228 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4015
Practice Address - Country:US
Practice Address - Phone:650-343-0549
Practice Address - Fax:650-343-1653
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12214T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist