Provider Demographics
NPI:1962192906
Name:LEE, BRIAN SCOTT (ABO 140728 CEC ID)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:SCOTT
Last Name:LEE
Suffix:
Gender:M
Credentials:ABO 140728 CEC ID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3271 ROUTE 940
Mailing Address - Street 2:
Mailing Address - City:MOUNT POCONO
Mailing Address - State:PA
Mailing Address - Zip Code:18344-1150
Mailing Address - Country:US
Mailing Address - Phone:570-895-4791
Mailing Address - Fax:570-895-4793
Practice Address - Street 1:3271 ROUTE 940
Practice Address - Street 2:
Practice Address - City:MOUNT POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344-1150
Practice Address - Country:US
Practice Address - Phone:570-895-4791
Practice Address - Fax:570-895-4793
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA140728156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician