Individual
DR. LEE U DE ROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
633 MAIN ST, LEWISTON, ME 04240-5938
(207) 783-8243
(207) 783-0021
Mailing address
633 MAIN ST, LEWISTON, ME 04240-5938
(207) 783-8243
(207) 783-0021
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT623
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
048845
ANTHEM BLUE CROSS
ME
05
—
125060099
—
ME
01
—
5536080001
DME
ME
Enumeration date
09/20/2006
Last updated
10/27/2010
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