Provider Demographics
NPI:1831353721
Name:A. LEE SCAIEF O D M S A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:A. LEE SCAIEF O D M S A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SCAIEF
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:209-847-1726
Mailing Address - Street 1:1390 W H ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3570
Mailing Address - Country:US
Mailing Address - Phone:209-847-1726
Mailing Address - Fax:209-847-0235
Practice Address - Street 1:1390 W H ST
Practice Address - Street 2:SUITE E
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3570
Practice Address - Country:US
Practice Address - Phone:209-847-1726
Practice Address - Fax:209-847-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5202T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0052020Medicaid
CADO3965OtherRAILROAD MEDICARE
CA0467540001OtherDMERC
CAT09904Medicare UPIN
CABA366Medicare PIN