Provider Demographics
NPI:1821047515
Name:WEBSTER, CHAN LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAN
Middle Name:LEE
Last Name:WEBSTER
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:PSC 10 BOX 126
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09142-0002
Mailing Address - Country:US
Mailing Address - Phone:910-446-3527
Mailing Address - Fax:
Practice Address - Street 1:LRMC OPTOMETRY SERVICE
Practice Address - Street 2:ATTN:MCEU-LCM-MSO, UNIT 33100
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:DE
Practice Address - Phone:314-590-7028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN1741152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist