Provider Demographics
NPI:1558994814
Name:DR. BRIAN LEE, OPTOMETRY, PLLC
Entity type:Organization
Organization Name:DR. BRIAN LEE, OPTOMETRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:346-763-7392
Mailing Address - Street 1:3450 CYPRESS CREEK PKWY
Mailing Address - Street 2:WALMART VISION
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-3606
Mailing Address - Country:US
Mailing Address - Phone:346-763-7392
Mailing Address - Fax:585-385-7969
Practice Address - Street 1:3450 CYPRESS CREEK PKWY
Practice Address - Street 2:WALMART VISION
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3606
Practice Address - Country:US
Practice Address - Phone:346-763-7392
Practice Address - Fax:585-385-7969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1356574503Medicaid