Provider Demographics
NPI:1831401215
Name:LEE, SARAH DILLE (OD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:DILLE
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:P.O. BOX 830941
Mailing Address - Street 2:MSC 559
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283
Mailing Address - Country:US
Mailing Address - Phone:205-325-8536
Mailing Address - Fax:205-325-8270
Practice Address - Street 1:700 18TH ST S
Practice Address - Street 2:STE 601
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3800
Practice Address - Country:US
Practice Address - Phone:205-975-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002641152W00000X
NYTUV007583152WP0200X
ALR-199-TA-886152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics