Provider Demographics
NPI:1033467915
Name:LEE, ALLEN MA (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN MA
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 WHITE BEAR AVE N STE B
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-5175
Mailing Address - Country:US
Mailing Address - Phone:651-447-2247
Mailing Address - Fax:
Practice Address - Street 1:2520 WHITE BEAR AVE N
Practice Address - Street 2:SUITE B
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-5136
Practice Address - Country:US
Practice Address - Phone:920-918-6119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3313152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist