Active NPI
Susan Lee, O.D.
- Optometrist
- Watonga, OK
National Provider Identifier
1417045949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1010
- Practice address
- 215 N Clarence Nash Blvd
Watonga, OK 73772-3645 - Phone
- (580) 623-2300
- Fax
- (580) 623-7533
- NPI assigned
- Oct 10, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1010 | OK | Primary |
Addresses
Primary practice location
215 N Clarence Nash Blvd
Watonga, OK 73772-3645
Mailing address
215 N Clarence Nash Blvd
Watonga, OK 73772-3645
Phone (580) 623-2300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1010 | Other | OK | LICENSE |
| 100760870A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100827000725 | OK | Practitioner - Optometry | 2466576491 | Practice locations: Watonga, OK |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- University of Houston - College of Optometry, 1981
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
215 N Clarence Nash Blvd
Watonga, OK 73772-3645
Phone (580) 623-2300
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 72 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1010 | OK | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288224000000",
"number": "1417045949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 N CLARENCE NASH BLVD",
"city": "WATONGA",
"state": "OK",
"postal_code": "737723645",
"telephone_number": "580-623-2300",
"fax_number": "580-623-7533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 N CLARENCE NASH BLVD",
"city": "WATONGA",
"state": "OK",
"postal_code": "737723645",
"telephone_number": "580-623-2300",
"fax_number": "580-623-7533"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "SUSAN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-10",
"last_updated": "2010-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OK",
"license": "1010",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "1010",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100760870A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Watonga, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2010; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.