Provider Demographics
NPI:1356435432
Name:LEE, RALPH ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ALAN
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 1706
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:AZ
Mailing Address - Zip Code:85939-1706
Mailing Address - Country:US
Mailing Address - Phone:520-369-2020
Mailing Address - Fax:
Practice Address - Street 1:7740 JAMES PEARCE WAY B#1706
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:AZ
Practice Address - Zip Code:85939-1706
Practice Address - Country:US
Practice Address - Phone:520-369-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ557152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ034124Medicaid
AZ034124Medicaid
ML0627919OtherDEA#
U05890Medicare UPIN