Active NPI
Kelly C Lee, OD
- Optometrist
- Shoreline, WA
National Provider Identifier
1750424560
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OD3674
- Practice address
- 15711 Aurora Ave N
Shoreline, WA 98133-5921 - Phone
- (206) 440-1227
- Fax
- (206) 363-2296
- NPI assigned
- Feb 14, 2007
- 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 | OD3674 | WA | Primary |
Addresses
Primary practice location
15711 Aurora Ave N
Shoreline, WA 98133-5921
Mailing address
15422 NE 54TH PL
Redmond, WA 98052-5168
Phone (425) 882-4731
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121112 | Other | WA | EYEMED DOC NUMBER |
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
| License | State | Type | Specialty |
|---|---|---|---|
| OD3674 | WA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171411200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750424560",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15422 NE 54TH PL",
"city": "REDMOND",
"state": "WA",
"postal_code": "980525168",
"telephone_number": "425-882-4731",
"fax_number": "425-882-4731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15711 AURORA AVE N",
"city": "SHORELINE",
"state": "WA",
"postal_code": "981335921",
"telephone_number": "206-440-1227",
"fax_number": "206-363-2296"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "KELLY",
"middle_name": "C",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "OD3674",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYEMED DOC NUMBER",
"identifier": "121112",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shoreline, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.