Provider Demographics
NPI:1790934842
Name:LEE, ADAM JAMES (OD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JAMES
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 1:10750 W MCDOWELL RD
Mailing Address - Street 2:STE. A100
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5960
Mailing Address - Country:US
Mailing Address - Phone:623-877-3007
Mailing Address - Fax:623-877-4488
Practice Address - Street 1:10750 W MCDOWELL RD
Practice Address - Street 2:STE. A100
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5960
Practice Address - Country:US
Practice Address - Phone:623-877-3007
Practice Address - Fax:623-877-4488
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-13
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist