Individual
ABIGAIL GRACE LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Mailing address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18004514A
IN
Other
Enumeration date
07/31/2024
Last updated
07/31/2024
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