Provider Demographics
NPI:1780811281
Name:LEE, ANITA LYMON OWYANG (OD)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:LYMON OWYANG
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:ANITA
Other - Middle Name:LYMON
Other - Last Name:OWYANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:615 SEPULVEDA PL
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-4292
Mailing Address - Country:US
Mailing Address - Phone:510-206-9510
Mailing Address - Fax:714-256-9218
Practice Address - Street 1:100 BREA MALL
Practice Address - Street 2:SEARS OPTOMETRY
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5717
Practice Address - Country:US
Practice Address - Phone:714-990-4353
Practice Address - Fax:714-256-9218
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2014-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13655 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist