Active NPI
Amanda K Lee, O.D.
- Optometrist
- Myrtle Beach, SC
National Provider Identifier
1871572453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1644
- Practice address
- 109 Finnegan CT
Myrtle Beach, SC 29579-4205 - Phone
- (843) 903-0949
- Fax
- (843) 903-1101
- NPI assigned
- Jan 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1800 | NC | |
| Optometrist | 152W00000X | 1644 | SC | Primary |
Addresses
Primary practice location
109 Finnegan CT
Myrtle Beach, SC 29579-4205
Mailing address
PO Box 50997
Myrtle Beach, SC 29579-0017
Phone (843) 903-0949
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89093HG | Medicaid | NC | |
| 22-00212 | Other | NC | UNITED HEALTHCARE NUMBER |
| 093HG | Other | NC | BCBS 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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1800 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| 1644 | SC | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Briana J. Shelton OD PA | Optometrist | Past | Accepting new patients |
| Elite Eye Care, O.D, P.L.L.C | Optometrist | Past | Accepting new patients |
| Ammons Perry Optometric, PLLC | Optometrist | Past | Accepting new patients |
| Tammy T. Tully OD PA | Optometrist | Past | Accepting new patients |
Organizations & group practices 4
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.
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- NPI 1922169994
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349049600000",
"number": "1871572453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 50997",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295790017",
"telephone_number": "843-903-0949",
"fax_number": "843-903-1101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 FINNEGAN CT",
"city": "MYRTLE BEACH",
"state": "SC",
"postal_code": "295794205",
"telephone_number": "843-903-0949",
"fax_number": "843-903-1101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEE",
"first_name": "AMANDA",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-12",
"last_updated": "2012-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NC",
"license": "1800",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "SC",
"license": "1644",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89093HG",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE NUMBER",
"identifier": "22-00212",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NUMBER",
"identifier": "093HG",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Myrtle Beach, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.