Provider Demographics
NPI:1659710192
Name:LEE, SARAH KWON (OD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:KWON
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 CAMPUS RIDGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5077
Mailing Address - Country:US
Mailing Address - Phone:704-234-1930
Mailing Address - Fax:833-231-6851
Practice Address - Street 1:1200 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3370
Practice Address - Country:US
Practice Address - Phone:704-825-9002
Practice Address - Fax:704-825-9002
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV07966152W00000X
MI4901004887152W00000X
SC2216152W00000X
NC2666152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty