Provider Demographics
NPI:1902231079
Name:LEE, LEONEL (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:LEONEL
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3006
Mailing Address - Country:US
Mailing Address - Phone:609-883-1800
Mailing Address - Fax:609-406-9609
Practice Address - Street 1:1330 PARKWAY AVE
Practice Address - Street 2:
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08628-3006
Practice Address - Country:US
Practice Address - Phone:609-883-1800
Practice Address - Fax:609-406-9609
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTD3282156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician