Provider Demographics
NPI:1487647848
Name:LEE, BENJAMIN F (OD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:F
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 1:7100 SIX FORKS RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6156
Mailing Address - Country:US
Mailing Address - Phone:919-847-0187
Mailing Address - Fax:919-676-2231
Practice Address - Street 1:7020 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6430
Practice Address - Country:US
Practice Address - Phone:919-847-5957
Practice Address - Fax:919-846-3951
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914423Medicaid
NC7909256Medicaid
NC410027457OtherRAILROAD MEDICARE
NC0907VOtherBLUECROSS
NCNC2407DMedicare PIN
NCNC2407FMedicare PIN
NCU48929Medicare UPIN
NCNC2407HMedicare PIN
NC2469069DMedicare PIN
NC0907VOtherBLUECROSS
NCNC2407BMedicare PIN
NCNC2407IMedicare PIN
NCNC2407AMedicare PIN
NCNC2407GMedicare PIN
NCNC2407EMedicare PIN
NCNC2407CMedicare PIN