Individual provider Active NPI

Elizabeth Josephine Lee, O.D.

  • Optometrist
  • Port Orange, FL
National Provider Identifier
1295126167
Registry record updated Feb 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC 4924 Issued in FL
Practice address
1771 Dunlawton Ave
Port Orange, FL 32127-4757
Phone
(386) 304-3328
NPI assigned
Feb 12, 2015
Last updated
Feb 12, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 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 OPC 4924 FL Primary

Addresses

Primary practice location

1771 Dunlawton Ave
Port Orange, FL 32127-4757

Mailing address

1417 Royal Grove LN
Port Orange, FL 32129-8620
Phone (954) 665-7358

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC 4924FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Suncoast Eyecare Centers PLLC Optometrist Past Accepting new patients
Elizabeth Lee OD PA Optometrist Past Accepting new patients
Cape Coral Eye Center, P.a. Optometrist Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1423699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423699200000",
    "number": "1295126167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 ROYAL GROVE LN",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321298620",
            "telephone_number": "954-665-7358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1771 DUNLAWTON AVE",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321274757",
            "telephone_number": "386-304-3328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "ELIZABETH",
        "middle_name": "JOSEPHINE",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-12",
        "last_updated": "2015-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 4924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.