Provider Demographics
NPI:1336115658
Name:LOU LEE, STELLA (OD)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:LOU LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:
Other - Last Name:LOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:17 ELIZABETH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4803
Mailing Address - Country:US
Mailing Address - Phone:212-226-3937
Mailing Address - Fax:212-226-3372
Practice Address - Street 1:17 ELIZABETH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4803
Practice Address - Country:US
Practice Address - Phone:212-226-3937
Practice Address - Fax:212-226-3372
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC389E1OtherBLUE CROSS BLUE SHIELD
NY6501889OtherGHI
NYP2576713OtherOXFORD
NY02239632Medicaid
NYC389E1OtherBLUE CROSS BLUE SHIELD
NYP2576713OtherOXFORD