Provider Demographics
NPI:1720225022
Name:LEE, GYURO
Entity Type:Individual
Prefix:MRS
First Name:GYURO
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YECHE
Other - Middle Name:
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2442 PLEASANT HILL RD
Mailing Address - Street 2:#4
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1700
Mailing Address - Country:US
Mailing Address - Phone:678-417-0100
Mailing Address - Fax:678-417-0100
Practice Address - Street 1:2442 PLEASANT HILL RD
Practice Address - Street 2:#4
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1700
Practice Address - Country:US
Practice Address - Phone:678-417-0100
Practice Address - Fax:678-417-0100
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist