Provider Demographics
NPI:1649342262
Name:LEE, TRACI MAY (OD)
Entity type:Individual
Prefix:DR
First Name:TRACI
Middle Name:MAY
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 1:4815 48TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1831
Mailing Address - Country:US
Mailing Address - Phone:206-723-9070
Mailing Address - Fax:
Practice Address - Street 1:901 S GRADY WAY
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-3226
Practice Address - Country:US
Practice Address - Phone:425-793-7946
Practice Address - Fax:425-793-9662
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD3918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist