Provider Demographics
NPI:1457442410
Name:LEE, SHERYN SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:SHERYN
Middle Name:SUE
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:9636 GARDEN GROVE BLVD
Mailing Address - Street 2:#5
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844
Mailing Address - Country:US
Mailing Address - Phone:714-537-1313
Mailing Address - Fax:714-537-9180
Practice Address - Street 1:9636 GARDEN GROVE BLVD
Practice Address - Street 2:#5
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844
Practice Address - Country:US
Practice Address - Phone:714-537-1313
Practice Address - Fax:714-537-9180
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2020-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA10348T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0103480Medicaid
CA1134201650Medicare NSC
CADH344ZMedicare PIN