Active NPI
Stephanie H. Lee, O.D.
- Optometrist
- Chandler, AZ
National Provider Identifier
1205055662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1612
- Practice address
- 220 N McKemy Ave
Chandler, AZ 85226-2654 - Phone
- (480) 961-1865
- NPI assigned
- Apr 24, 2007
- Last updated
- Aug 25, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1612 | AZ | Primary |
| Optometrist | 152W00000X | 12211T | CA |
Addresses
Primary practice location
220 N McKemy Ave
Chandler, AZ 85226-2654
Mailing address
220 N McKemy Ave
Chandler, AZ 85226-2654
Phone (480) 961-1865
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3747037 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12211T | CA | MD | Optometrist |
| 1612 | AZ | MD | Hand Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Total Vision PC | Optometrist | Past | Accepting new patients |
| Golden San Gabriel Optometric Vision Center | Optometrist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optometrist
- San Gabriel, CA
- NPI 1740216936
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219622400000",
"number": "1205055662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "220 N MCKEMY AVE",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852262654",
"telephone_number": "480-961-1865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 N MCKEMY AVE",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852262654",
"telephone_number": "480-961-1865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "STEPHANIE",
"middle_name": "H.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-24",
"last_updated": "2008-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AZ",
"license": "1612",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "12211T",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3747037",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chandler, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.