Provider Demographics
NPI:1366440018
Name:LEE, ANNE CINDY (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:CINDY
Last Name:LEE
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5019
Mailing Address - Country:US
Mailing Address - Phone:917-554-5336
Mailing Address - Fax:
Practice Address - Street 1:13427 INGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5608
Practice Address - Country:US
Practice Address - Phone:310-676-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13467152WP0200X, 152W00000X
AZ1324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11423229OtherCAQH UNIVERSAL CREDENTIAL
AZVO1414Medicare UPIN
AZZ84126Medicare PIN
AZVO1414Medicare UPIN