Provider Demographics
NPI:1346352648
Name:ANDY M LEE MD PA
Entity Type:Organization
Organization Name:ANDY M LEE MD PA
Other - Org Name:TOTAL EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-296-2020
Mailing Address - Street 1:388 E HWY 67
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-4159
Mailing Address - Country:US
Mailing Address - Phone:972-296-2020
Mailing Address - Fax:972-296-0992
Practice Address - Street 1:388 E HWY 67
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-4159
Practice Address - Country:US
Practice Address - Phone:972-296-2020
Practice Address - Fax:972-296-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6009207W00000X
LA10613R207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00661GOtherBLUE CROSS BLUE SHIELD
TX1118747Medicaid
TX1118747Medicaid
G22235Medicare UPIN