Provider Demographics
NPI:1336379809
Name:LEE, NANNA KA-MAN (OD)
Entity Type:Individual
Prefix:DR
First Name:NANNA
Middle Name:KA-MAN
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 1:400 COMMONS WAY
Mailing Address - Street 2:BOX 327 #3310
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 COMMONS WAY STE 327
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2822
Practice Address - Country:US
Practice Address - Phone:908-704-8855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-19
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007441152W00000X
NJ27OA00670000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3811803OtherUNITED HEALTHCARE
NYA400104720Medicare PIN