Derron Timothy Lee, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

12387T Issued in CA

Practice address

2321 W March LN
Stockton, CA 95207-5261

Phone

(209) 986-1880

Fax

(209) 957-8077

NPI assigned

Sep 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Midtown Optometry Inc.

  • Optometrist
  • Stockton, CA
  • NPI 1639297898
  Medicare reassignment Authorized official
• Fred WM Stellhorn Optometric Corporation

  • Optometrist
  • Manteca, CA
  • NPI 1124290721
  NPD (past)
• Luxottica of America Inc

  • Eyewear Supplier
  • Kansas City, MO
  • NPI 1497412522
  NPD (past)

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

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1144313552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2321 W MARCH LN STE A",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075265",
            "telephone_number": "209-986-1880",
            "fax_number": "209-957-8077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 W MARCH LN",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952075261",
            "telephone_number": "209-986-1880",
            "fax_number": "209-957-8077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "DERRON",
        "middle_name": "TIMOTHY",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-30",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "12387T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MESC",
            "identifier": "11620",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "CA2387",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chiao Charlie Lee
• Chong Lee
• Christina Noelle Lee, PT, DPT
• Christine Rosabelle Lee, PA-C
• Cynthia Lee, PHARMD
• Dok Mai Ban Lee
• Dua Lee
• Emily Lee
• Jennifer Lynn Lee
• Ji Young Lee, M.D.

• Optometrist in Stockton, CA
• Providers in Stockton, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.