Provider Demographics
NPI:1528222049
Name:LEE EYE SURGERY CLINIC PA
Entity Type:Organization
Organization Name:LEE EYE SURGERY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONG
Authorized Official - Middle Name:HWA
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:972-395-7131
Mailing Address - Street 1:1948 E HEBRON PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1515
Mailing Address - Country:US
Mailing Address - Phone:972-395-7131
Mailing Address - Fax:972-395-7585
Practice Address - Street 1:1948 E HEBRON PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1515
Practice Address - Country:US
Practice Address - Phone:972-395-7131
Practice Address - Fax:972-395-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2406207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z923Medicare PIN