Active NPI
Kyung Min Lee
- Optometrist
- Decatur, GA
National Provider Identifier
1477238202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT003525
- Practice address
- 1781 Clairmont Rd
Decatur, GA 30033-4005 - Phone
- (404) 471-9990
- NPI assigned
- Jun 20, 2023
- Last updated
- Aug 10, 2023
- 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 | OPT003525 | GA | Primary |
Addresses
Primary practice location
1781 Clairmont Rd
Decatur, GA 30033-4005
Mailing address
2002 Wildcat Falls LN
Lawrenceville, GA 30043-2985
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- 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 |
|---|---|---|---|---|
| I20230822004383 | GA | Order and Referring Only - Optometry | 6103289236 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT003525 | GA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Suwanee Eye Center | Optometrist | Current | Accepting new patients |
Locations
1781 Clairmont Rd
Decatur, GA 30033
Phone (404) 471-9990
Organizations & group practices 1
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": "1687219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691625600000",
"number": "1477238202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2002 WILDCAT FALLS LN",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300432985"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1781 CLAIRMONT RD",
"city": "DECATUR",
"state": "GA",
"postal_code": "300334005",
"telephone_number": "404-471-9990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "KYUNG MIN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-06-20",
"last_updated": "2023-08-10",
"certification_date": "2023-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "GA",
"license": "OPT003525",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2023; 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.