Individual
SUSANA M LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2238 31ST ST, ASTORIA, NY 11105-2714
(718) 278-3600
Mailing address
2238 31ST ST, ASTORIA, NY 11105-2714
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV007020-1
NY
152WL0500X
Low Vision Rehabilitation Optometrist
27OA00593700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0061620
—
NJ
05
—
02841394
—
NY
Enumeration date
01/26/2006
Last updated
10/20/2007
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