Provider Demographics
NPI:1013939628
Name:LEE, SCOTT COLE (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:COLE
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:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901
Mailing Address - Country:US
Mailing Address - Phone:570-724-4216
Mailing Address - Fax:570-723-5092
Practice Address - Street 1:87 MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901
Practice Address - Country:US
Practice Address - Phone:570-724-4216
Practice Address - Fax:570-723-5092
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE5200P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005542410002Medicaid
0506060001Medicare NSC
T27227Medicare UPIN
PA0005542410002Medicaid