Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | IL |
NPI | 1013072990 |
---|---|
Provider Name | Dr. John C. Lee |
First Address | Decatur, IL 62521-5025 |
Second Address | Decatur, IL 62521-5025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001491 | HEALTH ALLIANCE (01) | IL |
0554210001 | DMEPOS (01) | IL |
D89418 | (02) | IL |