Provider Demographics
NPI:1235814278
Name:LEE, CODY JAMES (OD)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:JAMES
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 1:8222 AGORA PKWY STE 116A
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1319
Mailing Address - Country:US
Mailing Address - Phone:210-659-1479
Mailing Address - Fax:
Practice Address - Street 1:8222 AGORA PKWY STE 116A
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-1319
Practice Address - Country:US
Practice Address - Phone:210-659-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10878152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist