Healthcare Provider Details

I. General information

NPI: 1881899441
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: 06/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18513 BEAR CREEK TER
LEESBURG VA
20176-7424
US

IV. Provider business mailing address

18513 BEAR CREEK TER
LEESBURG VA
20176
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: DR. LUCY S LEE
Title or Position: OWNER
Credential: O.D.
Phone: 571-333-1250