Provider Demographics
NPI:1407289259
Name:LEE, SCOTT FREDERICK (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:FREDERICK
Last Name:LEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15555 HUNTINGTON VILLAGE LN
Mailing Address - Street 2:APT 191
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3054
Mailing Address - Country:US
Mailing Address - Phone:714-893-5979
Mailing Address - Fax:949-642-4900
Practice Address - Street 1:361 HOSPITAL RD
Practice Address - Street 2:SUITE 327
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3522
Practice Address - Country:US
Practice Address - Phone:949-642-3100
Practice Address - Fax:949-642-4900
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11911T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist