Provider Demographics
NPI:1568776151
Name:LEE, GRACE (OD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9520 GARDEN GROVE BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1528
Mailing Address - Country:US
Mailing Address - Phone:714-530-6700
Mailing Address - Fax:714-530-4273
Practice Address - Street 1:9520 GARDEN GROVE BLVD STE 5
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1528
Practice Address - Country:US
Practice Address - Phone:714-530-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13863152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist