Provider Demographics
NPI:1487818019
Name:JOHN J LEE, O.D.
Entity Type:Organization
Organization Name:JOHN J LEE, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-585-1668
Mailing Address - Street 1:101 INDEPENDENCE MALL WAY # C104
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-3048
Mailing Address - Country:US
Mailing Address - Phone:781-585-1668
Mailing Address - Fax:781-582-3872
Practice Address - Street 1:101 INDEPENDENCE MALL WAY # C104
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-3048
Practice Address - Country:US
Practice Address - Phone:781-585-1668
Practice Address - Fax:781-582-3872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-13
Last Update Date:2008-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4502152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW17587Medicare PIN