Susana M Lee, OD | |
2238 31st St, Astoria, NY 11105-2714 | |
(718) 278-3600 | |
Not Available |
Full Name | Susana M Lee |
---|---|
Gender | Female |
Speciality | Optometrist |
Location | 2238 31st St, Astoria, New York |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1679543003 | NPI | - | NPPES |
02841394 | Medicaid | NY | |
0061620 | Medicaid | NJ |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152WL0500X | Optometrist - Low Vision Rehabilitation | 27OA00593700 (New Jersey) | Secondary |
152W00000X | Optometrist | TUV007020-1 (New York) | Primary |
Provider Name | Odyssey Optics Ltd |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1962594200 PECOS PAC ID: 8628070240 Enrollment ID: O20070212000449 |
Mailing Address | Practice Location Address |
---|---|
Susana M Lee, OD 2238 31st St, Astoria, NY 11105-2714 Ph: () - | Susana M Lee, OD 2238 31st St, Astoria, NY 11105-2714 Ph: (718) 278-3600 |
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