Provider Demographics
NPI:1003963836
Name:LEE, CYNDI C (OD)
Entity Type:Individual
Prefix:
First Name:CYNDI
Middle Name:C
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 1:5308 PACIFIC AVE
Mailing Address - Street 2:SHERWOOD MALL
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5619
Mailing Address - Country:US
Mailing Address - Phone:415-652-2139
Mailing Address - Fax:
Practice Address - Street 1:1558 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-6108
Practice Address - Country:US
Practice Address - Phone:408-371-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist