Provider Demographics
NPI:1710113352
Name:LEE, BRADFORD WILLIAM (MD, MSC)
Entity Type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:WILLIAM
Last Name:LEE
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:MSC 61532 P.O. BOX 1300
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96807-1300
Mailing Address - Country:US
Mailing Address - Phone:808-888-9981
Mailing Address - Fax:
Practice Address - Street 1:1380 LUSITANA ST STE 912
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2448
Practice Address - Country:US
Practice Address - Phone:808-888-9981
Practice Address - Fax:808-468-4753
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR-5715207W00000X
FLTRN 15107207W00000X
FLME124928207W00000X
CAA124892207W00000X
HIMD-18295207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology