Provider Demographics
NPI:1275620353
Name:LEE, THOMAS C (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2323 KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-7307
Mailing Address - Country:US
Mailing Address - Phone:805-652-6255
Mailing Address - Fax:805-641-4494
Practice Address - Street 1:3291 LOMA VISTA RD BLDG 340
Practice Address - Street 2:SUITE 302
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3099
Practice Address - Country:US
Practice Address - Phone:805-652-6255
Practice Address - Fax:805-641-4494
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY197701207W00000X
CAG87847207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01960934Medicaid
NY01960934Medicaid
NY41Z071/G46440Medicare ID - Type Unspecified