Provider Demographics
NPI:1205166386
Name:LEE, PETER B (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:B
Last Name:LEE
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:BOX NUMBER 558
Mailing Address - Street 2:121 COMBAT SUPPORT HOSPITAL
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205-5244
Mailing Address - Country:US
Mailing Address - Phone:315-725-3601
Mailing Address - Fax:315-725-5442
Practice Address - Street 1:4518 186TH ST
Practice Address - Street 2:#110
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4669
Practice Address - Country:US
Practice Address - Phone:315-725-3601
Practice Address - Fax:315-725-5442
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA10116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist