Provider Demographics
NPI:1346696812
Name:DR. PALMER N. LEE, OD INC
Entity Type:Organization
Organization Name:DR. PALMER N. LEE, OD INC
Other - Org Name:EYECENTER OPTOMETRIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PALMER
Authorized Official - Middle Name:N
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-983-1066
Mailing Address - Street 1:421 BLUE RAVINE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3821
Mailing Address - Country:US
Mailing Address - Phone:916-983-1066
Mailing Address - Fax:916-984-6922
Practice Address - Street 1:421 BLUE RAVINE RD STE 300
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3821
Practice Address - Country:US
Practice Address - Phone:916-983-1066
Practice Address - Fax:916-984-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT5895TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0058952Medicare PIN