Provider Demographics
NPI:1093857591
Name:LEE, NICOLE HELEN (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:HELEN
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 1:401 BLANCO CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2001
Mailing Address - Country:US
Mailing Address - Phone:925-743-4098
Mailing Address - Fax:925-743-4098
Practice Address - Street 1:490 POST ST
Practice Address - Street 2:SUITE 1440
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1401
Practice Address - Country:US
Practice Address - Phone:415-392-4437
Practice Address - Fax:415-392-8622
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOD11427T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOD11427TOtherOPTOMETRIC LICENSE