Individual provider Active NPI

Bo Rum Lee, OD

  • Optometrist
  • Alpharetta, GA
National Provider Identifier
1639986771
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT003633 Issued in GA
Practice address
2855 Jordan CT
Alpharetta, GA 30004-3869
Phone
(678) 823-4954
NPI assigned
Dec 12, 2024
Last updated
Dec 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT003633 GA Primary

Addresses

Primary practice location

2855 Jordan CT
Alpharetta, GA 30004-3869

Mailing address

7325 Craigleith Dr
Duluth, GA 30097-1605

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

State licenses

LicenseStateTypeSpecialty
OPT003633GAMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1733961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1639986771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7325 CRAIGLEITH DR",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300971605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 JORDAN CT",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300043869",
            "telephone_number": "678-823-4954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEE",
        "first_name": "BO RUM",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-12",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT003633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; 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.