Provider Demographics
NPI:1932592763
Name:LEE, CHARLES S (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:S
Last Name:LEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 MONDAVI WAY
Mailing Address - Street 2:UNIT B4
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-4346
Mailing Address - Country:US
Mailing Address - Phone:323-717-6046
Mailing Address - Fax:
Practice Address - Street 1:9000 MING AVE
Practice Address - Street 2:SUITE L1B
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1318
Practice Address - Country:US
Practice Address - Phone:661-664-3314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15373152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist