Provider Demographics
NPI:1700822046
Name:LEE, WILLIAM P (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
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 1:7773 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-2431
Mailing Address - Country:US
Mailing Address - Phone:901-872-3937
Mailing Address - Fax:901-872-3945
Practice Address - Street 1:7773 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-2431
Practice Address - Country:US
Practice Address - Phone:901-872-3937
Practice Address - Fax:901-872-3945
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN678152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNT61180Medicare UPIN
TN3948016Medicare PIN