Provider Demographics
NPI:1013977305
Name:LEE, DAVID D (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
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 1:133 S KNOWLES AVE
Mailing Address - Street 2:PO BOX 29
Mailing Address - City:NEW RICHMOND
Mailing Address - State:WI
Mailing Address - Zip Code:54017-1726
Mailing Address - Country:US
Mailing Address - Phone:715-246-3937
Mailing Address - Fax:715-246-3435
Practice Address - Street 1:133 S KNOWLES AVE
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-1726
Practice Address - Country:US
Practice Address - Phone:715-246-3937
Practice Address - Fax:715-246-3435
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1591035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38504300Medicaid
0816080001Medicare NSC
WI87521Medicare ID - Type Unspecified
WI38504300Medicaid