Provider Demographics
NPI:1285859900
Name:DR SALLY LEE
Entity Type:Organization
Organization Name:DR SALLY LEE
Other - Org Name:SAN DIEGO EYE PROFESSIONALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:SUK YEE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,DO
Authorized Official - Phone:619-583-4295
Mailing Address - Street 1:5965 SEVERIN DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3428
Mailing Address - Country:US
Mailing Address - Phone:619-583-4295
Mailing Address - Fax:619-825-7300
Practice Address - Street 1:5965 SEVERIN DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3806
Practice Address - Country:US
Practice Address - Phone:619-583-4295
Practice Address - Fax:619-825-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8088261QM2500X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457468514Medicaid
CA00AX80880Medicaid
CA20A8088Medicare ID - Type Unspecified