Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | 50 | SC |
Y | 156FX1800X | Optician | 262 | SC |
NPI | 1972551034 |
---|---|
Provider Name | George F Lee |
First Address | Mt Pleasant, SC 29464-3592 |
Second Address | Mt Pleasant, SC 29464-3592 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 12/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DV2621 | (05) | SC |