Individual provider Active NPI

Edward Seungho Lee, O.D.

  • Optometrist
  • Federal Way, WA
National Provider Identifier
1083616288
Registry record updated Apr 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
WA2011 Issued in WA
Practice address
32020 32ND Ave S
Ste 130
Federal Way, WA 98001-9625
Phone
(253) 839-0600
Fax
(253) 941-7485
NPI assigned
Jun 1, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 10, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X WA2011 WA Primary

Addresses

Primary practice location

32020 32ND Ave S
Ste 130
Federal Way, WA 98001-9625

Mailing address

32020 32ND Ave S
Ste 130
Federal Way, WA 98001-9625
Phone (253) 839-0600

Other identifiers 1

IdentifierTypeStateIssuer
2013498MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051025001054 WA Practitioner - Optometry 4789601113 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

32020 32ND Ave S
Federal Way, WA 98001-9349
Phone (253) 839-0600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
WA2011WAMDOptometrist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428624000000",
    "number": "1083616288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32020 32ND AVE S",
            "address_2": "STE 130",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980019625",
            "telephone_number": "253-839-0600",
            "fax_number": "253-941-7485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32020 32ND AVE S",
            "address_2": "STE 130",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980019625",
            "telephone_number": "253-839-0600",
            "fax_number": "253-941-7485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "EDWARD",
        "middle_name": "SEUNGHO",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2015-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "WA2011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2013498",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

Verify at the official NPI Registry.