Provider Demographics
NPI:1043381171
Name:LEE EYE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:LEE EYE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-333-0054
Mailing Address - Street 1:1115 R ST NW
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-3848
Mailing Address - Country:US
Mailing Address - Phone:253-333-0054
Mailing Address - Fax:253-735-1861
Practice Address - Street 1:801 AUBURN WAY N
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4162
Practice Address - Country:US
Practice Address - Phone:253-735-4732
Practice Address - Fax:253-735-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3561TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029148Medicaid
WA8853341Medicare PIN
WA2029148Medicaid
WA8853340Medicare PIN