Provider Demographics
NPI:1326355900
Name:LEE, BRANDI MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:MICHELLE
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303A GLYNN AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4406
Mailing Address - Country:US
Mailing Address - Phone:912-466-9500
Mailing Address - Fax:912-466-9922
Practice Address - Street 1:101 DARLING AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5219
Practice Address - Country:US
Practice Address - Phone:912-584-0047
Practice Address - Fax:912-490-1498
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002610152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003124649AMedicaid