Provider Demographics
NPI:1235683582
Name:CONNIE C. LEE, OD, PLLC
Entity Type:Organization
Organization Name:CONNIE C. LEE, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-848-9600
Mailing Address - Street 1:1100 N MERIDIAN
Mailing Address - Street 2:ATTN: VISTA OPTICAL
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-4403
Mailing Address - Country:US
Mailing Address - Phone:253-848-9600
Mailing Address - Fax:253-848-2597
Practice Address - Street 1:1100 N MERIDIAN
Practice Address - Street 2:ATTN: VISTA OPTICAL
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-4403
Practice Address - Country:US
Practice Address - Phone:253-848-9600
Practice Address - Fax:253-848-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60484667152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty