Basic Information
| Provider Information | |||||||||
| NPI: | 1710113352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | BRADFORD | ||||||||
| MiddleName: | WILLIAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., M.SC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | MSC 61532 P.O. BOX 1300 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968071300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088889981 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1380 LUSITANA ST STE 912 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968132448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088889981 | ||||||||
| FaxNumber: | 8084684753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2009 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MDR-5715 | HI | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | TRN 15107 | FL | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | ME124928 | FL | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | A124892 | CA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | MD-18295 | HI | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.