Provider Demographics
NPI:1114350105
Name:LEE, JESSI (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSI
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 1:72 HUDSON ST
Mailing Address - Street 2:APT 3D
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5629
Mailing Address - Country:US
Mailing Address - Phone:609-658-1867
Mailing Address - Fax:
Practice Address - Street 1:2000 WALDEN AVE
Practice Address - Street 2:C203
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-5454
Practice Address - Country:US
Practice Address - Phone:716-833-0803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008207152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist