Provider Demographics
NPI:1972549442
Name:DR SYLVIA K LEE, OD, PHD
Entity type:Organization
Organization Name:DR SYLVIA K LEE, OD, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PHD
Authorized Official - Phone:831-674-1063
Mailing Address - Street 1:386 S GREEN VALLEY RD
Mailing Address - Street 2:#2
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3099
Mailing Address - Country:US
Mailing Address - Phone:831-674-1063
Mailing Address - Fax:831-674-1067
Practice Address - Street 1:386 S GREEN VALLEY RD
Practice Address - Street 2:#2
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3099
Practice Address - Country:US
Practice Address - Phone:831-674-1063
Practice Address - Fax:831-674-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12225T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U83027Medicare UPIN
NYC68691Medicare ID - Type Unspecified