Provider Demographics
NPI:1346493343
Name:DRS. LEE & LEE OPTOMETRISTS, P.C.
Entity Type:Organization
Organization Name:DRS. LEE & LEE OPTOMETRISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEE
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:970-669-2040
Mailing Address - Street 1:2004 W 15TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-3596
Mailing Address - Country:US
Mailing Address - Phone:970-669-2040
Mailing Address - Fax:970-669-2041
Practice Address - Street 1:2004 W 15TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-3596
Practice Address - Country:US
Practice Address - Phone:970-669-2040
Practice Address - Fax:970-669-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO855332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04016119Medicaid
CO0498370001Medicare NSC
COT60720Medicare UPIN
COCOB4473Medicare PIN