Provider Demographics
NPI:1972512127
Name:LEE, KRISTEN ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:ANN
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 1:21739 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-3302
Mailing Address - Country:US
Mailing Address - Phone:310-513-6900
Mailing Address - Fax:310-513-1445
Practice Address - Street 1:21739 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-3302
Practice Address - Country:US
Practice Address - Phone:310-513-6900
Practice Address - Fax:310-513-1445
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13040T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist