Provider Demographics
NPI:1871644757
Name:LEE, WILLIAM P (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
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 1:3432 JUDAH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1327
Mailing Address - Country:US
Mailing Address - Phone:415-205-4824
Mailing Address - Fax:
Practice Address - Street 1:3251 20TH AVE
Practice Address - Street 2:STONESTOWN GALLERIA SPACE 219
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1900
Practice Address - Country:US
Practice Address - Phone:415-566-8394
Practice Address - Fax:415-566-9187
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10016152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU98170Medicare UPIN
CASD0100160Medicare ID - Type Unspecified