Healthcare Provider Details

I. General information

NPI: 1609795384
Provider Name (Legal Business Name): MAYLYNN LEE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 SELWYN AVE APT 1C
BRONX NY
10457-7628
US

IV. Provider business mailing address

418 E 88TH ST APT 4C
NEW YORK NY
10128-6672
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-2041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011436
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: