Basic Information
| Provider Information | |||||||||
| NPI: | 1902938368 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEE | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | Y. M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 SUNRISE MALL | ||||||||
| Address2: | VISION CENTER | ||||||||
| City: | MASSAPEQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117584340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167995261 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 25121 JAMAICA # 2027 | ||||||||
| Address2: | |||||||||
| City: | BELLEROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114262218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188073515 | ||||||||
| FaxNumber: | 5164882003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 08/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | TUV005665 | NY | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.