Provider Demographics
NPI:1851415418
Name:LEE, MONICA (OD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
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 1:321 BROAD AVE
Mailing Address - Street 2:SUITE #120
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-2346
Mailing Address - Country:US
Mailing Address - Phone:201-313-3345
Mailing Address - Fax:201-313-3441
Practice Address - Street 1:321 BROAD AVE
Practice Address - Street 2:SUITE #120
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-2346
Practice Address - Country:US
Practice Address - Phone:201-313-3345
Practice Address - Fax:201-313-3441
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00575200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU99259Medicare UPIN