Provider Demographics
NPI:1568536043
Name:LEE, PAUL J
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:J
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6637 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5974
Mailing Address - Country:US
Mailing Address - Phone:716-632-1595
Mailing Address - Fax:716-204-4895
Practice Address - Street 1:6637 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5974
Practice Address - Country:US
Practice Address - Phone:716-632-1595
Practice Address - Fax:716-204-4895
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228517207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02430019Medicaid
NY02430019Medicaid
NYH84715Medicare UPIN