Provider Demographics
NPI:1306815220
Name:LEE-FAUST, CAROL S (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:S
Last Name:LEE-FAUST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:S
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1920 E BASELINE RD
Mailing Address - Street 2:CJ HARRIS CENTER / CIGNA MEDICAL GROUP/ OPHTHALMOLOGY
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1511
Mailing Address - Country:US
Mailing Address - Phone:480-345-5164
Mailing Address - Fax:480-345-5386
Practice Address - Street 1:1920 E BASELINE RD
Practice Address - Street 2:CJ HARRIS CENTER / CIGNA MEDICAL GROUP/ OPHTHALMOLOGY
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1511
Practice Address - Country:US
Practice Address - Phone:480-345-5164
Practice Address - Fax:480-345-5386
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37769207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ124134OtherMEDICARE
AZ282487Medicaid