Provider Demographics
NPI:1972551034
Name:LEE, GEORGE F (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:F
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 1:401 W COLEMAN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3592
Mailing Address - Country:US
Mailing Address - Phone:843-884-7321
Mailing Address - Fax:
Practice Address - Street 1:401 W COLEMAN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3592
Practice Address - Country:US
Practice Address - Phone:843-884-7321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC262156FX1800X
SC50156FC0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDV2621Medicaid
SC0172770001Medicare NSC