Provider Demographics
NPI:1457126567
Name:LEE, SARAH SONG (OD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SONG
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 1:1023 WILLOW FIELD LN SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4008
Mailing Address - Country:US
Mailing Address - Phone:678-951-4053
Mailing Address - Fax:
Practice Address - Street 1:3625 DALLAS HWY SW STE 615
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5907
Practice Address - Country:US
Practice Address - Phone:678-820-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003541152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist