Provider Demographics
NPI:1851491732
Name:LEE, ANTHONY M (OD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
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 1:166 SILVER ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5815
Mailing Address - Country:US
Mailing Address - Phone:207-873-3500
Mailing Address - Fax:207-873-3500
Practice Address - Street 1:166 SILVER ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5815
Practice Address - Country:US
Practice Address - Phone:207-873-3500
Practice Address - Fax:207-873-3500
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2014-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT838152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMN3981OtherHARVARD PILGRIM
ME023215OtherANTHEM
ME255520099Medicaid
ME023215OtherANTHEM
ME255520099Medicaid