Provider Demographics
NPI:1720210388
Name:LEE, AARON (OD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3924 N TARRANT PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-5410
Mailing Address - Country:US
Mailing Address - Phone:817-514-2114
Mailing Address - Fax:
Practice Address - Street 1:3924 N TARRANT PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-5410
Practice Address - Country:US
Practice Address - Phone:817-514-2114
Practice Address - Fax:817-514-2150
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7408TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist