Provider Demographics
NPI:1336292374
Name:LEE, LOUISE F (OD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:F
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 1:46228 WARM SPRINGS BLVD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7967
Mailing Address - Country:US
Mailing Address - Phone:510-668-0877
Mailing Address - Fax:
Practice Address - Street 1:46228 WARM SPRINGS BLVD
Practice Address - Street 2:SUITE 460
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7967
Practice Address - Country:US
Practice Address - Phone:510-668-0877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10508T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU49242Medicare UPIN