Provider Demographics
NPI:1801956503
Name:LEE, SUSAN STOWERS (OD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:STOWERS
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 1:1051 A PARK DR.
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-3465
Mailing Address - Country:US
Mailing Address - Phone:706-453-4535
Mailing Address - Fax:706-453-4539
Practice Address - Street 1:1051 A PARK DR.
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-3465
Practice Address - Country:US
Practice Address - Phone:706-453-4535
Practice Address - Fax:706-453-4539
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000672581LMedicaid
GA410045041OtherRAILROAD MEDICARE
GA4015930001Medicare NSC
GAGRP3665Medicare PIN
GAU57916Medicare UPIN