Provider Demographics
NPI:1952469785
Name:PAE, DORIS SUNHEE (OD)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:SUNHEE
Last Name:PAE
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 1:4972 ARCADO RD SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5106
Mailing Address - Country:US
Mailing Address - Phone:770-931-2640
Mailing Address - Fax:
Practice Address - Street 1:1133 E WEST CONNECTOR
Practice Address - Street 2:WAL-MART VISION CENTER
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1589
Practice Address - Country:US
Practice Address - Phone:404-409-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001957152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist