Provider Demographics
NPI:1174601504
Name:LEE, LUCY S (OD)
Entity type:Individual
Prefix:DR
First Name:LUCY
Middle Name:S
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12550 LEVAU CT
Mailing Address - Street 2:APT 204
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-6209
Mailing Address - Country:US
Mailing Address - Phone:703-802-0480
Mailing Address - Fax:
Practice Address - Street 1:19369 PROMENADE DRIVE
Practice Address - Street 2:K102
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-424-8690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist