Provider Demographics
NPI:1588677157
Name:LEE, DOUGLAS MOON (OD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MOON
Last Name:LEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1734 STATE ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3449
Mailing Address - Country:US
Mailing Address - Phone:732-393-1210
Mailing Address - Fax:732-393-1140
Practice Address - Street 1:1734 STATE ROUTE 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3449
Practice Address - Country:US
Practice Address - Phone:732-393-1210
Practice Address - Fax:732-393-1140
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ5303152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist