Provider Demographics
NPI:1760474142
Name:LEE, CARRIE (OD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
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 1:2786 DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-3057
Mailing Address - Country:US
Mailing Address - Phone:415-334-2020
Mailing Address - Fax:415-334-2020
Practice Address - Street 1:2786 DIAMOND ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-3057
Practice Address - Country:US
Practice Address - Phone:415-334-2020
Practice Address - Fax:415-594-9601
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12604T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V00225Medicare UPIN
SD0126040Medicare ID - Type Unspecified