Provider Demographics
NPI:1245382431
Name:LEE, DOUGLAS F (OD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:F
Last Name:LEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1928 SANTIAGO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1721
Mailing Address - Country:US
Mailing Address - Phone:415-665-6730
Mailing Address - Fax:
Practice Address - Street 1:1104 STONERIDGE MALL RD
Practice Address - Street 2:STONERIDGE SHP CTR
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3219
Practice Address - Country:US
Practice Address - Phone:925-463-3520
Practice Address - Fax:925-463-3526
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12965152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist