Provider Demographics
NPI:1639126048
Name:LEES, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:LEES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 WILLETTA ST SW STE B
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-3471
Mailing Address - Country:US
Mailing Address - Phone:541-926-5848
Mailing Address - Fax:541-926-2873
Practice Address - Street 1:2715 WILLETTA ST SW STE B
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3471
Practice Address - Country:US
Practice Address - Phone:541-926-5848
Practice Address - Fax:541-926-2873
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07355207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR108217Medicaid
OR108217Medicaid
R018WCKBCAMedicare PIN
ORC94413Medicare UPIN
OR182133455Medicare PIN
OR018WCKBCAMedicare ID - Type Unspecified