Healthcare Provider Details

I. General information

NPI: 1740594290
Provider Name (Legal Business Name): LUCY S. LEE, O.D., P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19369 PROMENADE DR SUITE K102
LANSDOWNE VA
20176-6501
US

IV. Provider business mailing address

19369 PROMENADE DR SUITE K102
LANSDOWNE VA
20176-6501
US

V. Phone/Fax

Practice location:
  • Phone: 571-333-1250
  • Fax: 571-333-1251
Mailing address:
  • Phone: 571-333-1250
  • Fax: 571-333-1251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618001284
License Number StateVA

VIII. Authorized Official

Name: MISS SHERRI SCHULTE
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 571-333-1250