Provider Demographics
NPI:1396361416
Name:CAROLINA K. LEE LLC
Entity Type:Organization
Organization Name:CAROLINA K. LEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:KEYJUNG
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-698-9130
Mailing Address - Street 1:17025 NE 108TH WAY
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-2794
Mailing Address - Country:US
Mailing Address - Phone:425-698-9130
Mailing Address - Fax:
Practice Address - Street 1:18805 STATE ROUTE 2
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1438
Practice Address - Country:US
Practice Address - Phone:360-805-9323
Practice Address - Fax:360-805-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty