Provider Demographics
NPI:1770579179
Name:ST PIERRE, LEE ANDREW (OD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANDREW
Last Name:ST PIERRE
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 1:2917 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7203
Mailing Address - Country:US
Mailing Address - Phone:870-802-2020
Mailing Address - Fax:870-931-7976
Practice Address - Street 1:2917 BROWNS LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7203
Practice Address - Country:US
Practice Address - Phone:870-802-2020
Practice Address - Fax:870-931-7976
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134079722Medicaid
AR49327OtherABCBS
1265260001Medicare NSC
ARU67887Medicare UPIN
AR49327Medicare PIN
AR134079722Medicaid