Provider Demographics
NPI:1912907429
Name:LEE, CONSTANCE (OD)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
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 1:940 COMMONWEALTH AVE SUITE 2
Mailing Address - Street 2:NEW ENGLAND EYE INSTITUTE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-262-2020
Mailing Address - Fax:617-236-6323
Practice Address - Street 1:930 COMMONWEALTH AVE
Practice Address - Street 2:#2A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1274
Practice Address - Country:US
Practice Address - Phone:617-262-2020
Practice Address - Fax:617-236-6323
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW16249OtherBCBS
MA30548OtherBMC
MA31511OtherNHP
MAMA4400OtherEYEMED
MA976490OtherNETWORK HEALTH
MAAA20532OtherHARVARD PILGRIM
MA334651Medicaid
MA2077157OtherUNITED HEALTH CARE
MA0334651OtherMASS HEALTH
MAW16249OtherBCBS
MAMA4400OtherEYEMED