Provider Demographics
NPI:1689419780
Name:LEE, STEPHANIE SANG WON (OD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SANG WON
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PLATEAU CRES.
Mailing Address - Street 2:
Mailing Address - City:NORTH YORK
Mailing Address - State:ON
Mailing Address - Zip Code:M3C 1M8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2701 184TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4739
Practice Address - Country:US
Practice Address - Phone:425-775-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD.OD.61581576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist