Provider Demographics
NPI:1780730333
Name:LEE, THOMAS YOUNG (OD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:YOUNG
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 1:4301 W WILLIAM CANNON DR
Mailing Address - Street 2:BUILDING A SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749
Mailing Address - Country:US
Mailing Address - Phone:512-891-9969
Mailing Address - Fax:512-891-9229
Practice Address - Street 1:4301 W WILLIAM CANNON DR
Practice Address - Street 2:BUILDING A SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749
Practice Address - Country:US
Practice Address - Phone:512-891-9969
Practice Address - Fax:512-891-9229
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6874T152W00000X
CA9164T152W00000X
OR2008T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX41920OtherSPECTERA VISION
TX41920OtherSPECTERA VISION
OR0000PHG57Medicare ID - Type Unspecified