MEDICARE: DR. JUDITH Y LEE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046.010297	IL

General Provider Information

NPI Number	:	1841524071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH Y LEE O.D.

Provider Business Mailing Address
First Line	:	3333 W TOUHY AVE
Second Line	:	#H1
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-2721
Country	:	US
Telephone Number	:	847-877-5756
Fax Number	:	847-675-8682

Provider Business Practice Location Address
First Line	:	3333 W TOUHY AVE
Second Line	:	H1
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-2721
Country	:	US
Telephone Number	:	847-675-7035
Fax Number	:	847-675-8682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2009
Last Update Date	:	09/28/2012

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