Provider Demographics
NPI:1932309119
Name:LEE, KATHLEEN H (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:H
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 1:1204 SPARROW MILL WAY
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6139
Mailing Address - Country:US
Mailing Address - Phone:410-420-1948
Mailing Address - Fax:
Practice Address - Street 1:1204 SPARROW MILL WAY
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6139
Practice Address - Country:US
Practice Address - Phone:410-420-1948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEP008536152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U66331Medicare UPIN