SUSANA M LEE OD
Complete NPI Record 1679543003
Optometrist in Astoria, NY
Active since January 26, 2006PECOS Enrolled
Complete NPI Dataset
This page contains the complete raw NPPES record for Susana M Lee, OD (NPI 1679543003), an individual optometrist provider in Astoria, NY. All 35 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1679543003 Field 1/35
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1 Field 2/35
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: LEE Field 3/35
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: SUSANA Field 4/35
- The first name of the provider, if the provider is an individual.
- Provider Middle Name: M Field 5/35
- The middle name of the provider, if the provider is an individual.
- Provider Credential Text: OD Field 6/35
- The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
- Provider First Line Business Mailing Address: 2238 31ST ST Field 7/35
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: ASTORIA Field 8/35
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: NY Field 9/35
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 111052714 Field 10/35
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/35
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider First Line Business Practice Location Address: 2238 31ST ST Field 12/35
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: ASTORIA Field 13/35
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: NY Field 14/35
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 111052714 Field 15/35
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 16/35
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 7182783600 Field 17/35
- The telephone number associated with the location address of the provider being identified.
- Provider Gender Code: F Field 20/35
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 152W00000X Field 21/35
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 1: TUV007020-1 Field 22/35
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 1: NY Field 23/35
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 24/35
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 152WL0500X Field 25/35
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 2: 27OA00593700 Field 26/35
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 2: NJ Field 27/35
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 28/35
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Other Provider Identifier 1: 0061620 Field 29/35
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 1: 05 Field 30/35
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 1: NJ Field 31/35
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Other Provider Identifier 2: 02841394 Field 32/35
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 2: 05 Field 33/35
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 2: NY Field 34/35
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Is Sole Proprietor: N Field 35/35
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
Other Provider Identifiers 5
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
02841394 Medicaid
Identifier 1/5State: NY
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
V02514 Medicare UPIN
Identifier 2/5State: NY
Medicare UPIN (Unique Physician Identification Number): A legacy six-character alphanumeric identifier previously issued by Medicare to individual physicians before being retired and replaced by the NPI system.
Medicare UPIN (Unique Physician Identification Number): A legacy six-character alphanumeric identifier previously issued by Medicare to individual physicians before being retired and replaced by the NPI system.
085924 Medicare ID-Type Unspecified
Identifier 3/5State: NJ
Medicare ID (Type Unspecified): A Medicare-issued provider identifier whose specific subtype or program context has not been designated.
Medicare ID (Type Unspecified): A Medicare-issued provider identifier whose specific subtype or program context has not been designated.
0061620 Medicaid
Identifier 4/5State: NJ
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
07935H Medicare PIN
Identifier 5/5State: NY
Medicare PIN: Used in legacy data fields alongside a healthcare provider's National Provider Identifier (NPI) to designate legacy Medicare provider numbers.
Medicare PIN: Used in legacy data fields alongside a healthcare provider's National Provider Identifier (NPI) to designate legacy Medicare provider numbers.
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