Provider Demographics
NPI:1447249222
Name:LEE, TERRY J (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:J
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:231 SE BARRINGTON DR
Mailing Address - Street 2:STE 208
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3200
Mailing Address - Country:US
Mailing Address - Phone:360-240-2020
Mailing Address - Fax:360-240-1989
Practice Address - Street 1:231 SE BARRINGTON DR
Practice Address - Street 2:STE 208
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3200
Practice Address - Country:US
Practice Address - Phone:360-240-2020
Practice Address - Fax:360-240-1989
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00025687207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1100148Medicaid
WA1100148Medicaid
WAG001100375Medicare PIN