Provider Demographics
NPI:1992884506
Name:LEE, SANDRA (OD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1715
Mailing Address - Country:US
Mailing Address - Phone:415-564-1818
Mailing Address - Fax:
Practice Address - Street 1:2007 IRVING ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1715
Practice Address - Country:US
Practice Address - Phone:415-564-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8528T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0538090001OtherCIGNA
CASD0085280Medicaid
CA8528TMedicare UPIN
CASD0085281Medicare PIN
CAZZZ25825ZMedicare ID - Type Unspecified
CA0538090001Medicare NSC