Individual
THOMAS LEES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3957 24TH AVE, FORT GRATIOT, MI 48059-4102
(810) 984-5005
Mailing address
1950 OLD GALLOWS RD STE 520, VIENNA, VA 22182-3970
(703) 847-8899
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003021
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
410003186
RAILROAD MEDICARE
MI
01
—
900G46508
BLUE CROSS PROVIDER
MI
Enumeration date
09/20/2005
Last updated
03/05/2021
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