Provider Demographics
NPI:1407026404
Name:LEE, GLORIA ANN (OPTICIAN/OWNER)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:ANN
Last Name:LEE
Suffix:
Gender:F
Credentials:OPTICIAN/OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2431
Mailing Address - Country:US
Mailing Address - Phone:706-965-2020
Mailing Address - Fax:706-965-2020
Practice Address - Street 1:192 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2431
Practice Address - Country:US
Practice Address - Phone:706-965-2020
Practice Address - Fax:706-965-2020
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician