NPIMap

Organization Active NPI

Elizabeth Lee OD PA

  • Optometrist
  • Port Orange, FL
National Provider Identifier
1376958371
Registry record updated Feb 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC 4924 Issued in FL
Legal business name
ELIZABETH LEE OD PA
Practice address
1771 Dunlawton Ave
Port Orange, FL 32127-4757
Phone
(954) 665-7358
NPI assigned
Jun 27, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2015

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

Authorized official

Name
Elizabeth Lee, O.D.NPI 1295126167
Title
President
Phone
(954) 665-7358

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 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

National Provider Directory

National Provider Directory

Locations

1771 Dunlawton Ave
Port Orange, FL 32127
Phone (386) 304-7360

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424822400000",
    "number": "1376958371",
    "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": "954-665-7358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZABETH LEE OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-27",
        "last_updated": "2015-02-25",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-665-7358",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  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 25, 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.