Provider Demographics
NPI:1164580296
Name:LEE, FRANKLIN (OD)
Entity Type:Individual
Prefix:DR
First Name:FRANKLIN
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 1:15100 HESPERIAN BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-3638
Mailing Address - Country:US
Mailing Address - Phone:510-276-6000
Mailing Address - Fax:
Practice Address - Street 1:15100 HESPERIAN BLVD
Practice Address - Street 2:STE 120
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3600
Practice Address - Country:US
Practice Address - Phone:510-276-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6490T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0064900Medicaid
CASD0064900Medicaid