Provider Demographics
NPI:1851621940
Name:TERRY J LEE MD PS
Entity Type:Organization
Organization Name:TERRY J LEE MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-240-2020
Mailing Address - Street 1:231 SE BARRINGTON DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3200
Mailing Address - Country:US
Mailing Address - Phone:360-240-2020
Mailing Address - Fax:360-240-1989
Practice Address - Street 1:231 SE BARRINGTON DR
Practice Address - Street 2:SUITE 208
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3200
Practice Address - Country:US
Practice Address - Phone:360-240-2020
Practice Address - Fax:360-240-1989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025687207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1100148Medicaid
G0011003725Medicare PIN
WA1100148Medicaid