Provider Demographics
NPI:1902356157
Name:LE, MICHELLE MY (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MY
Last Name:LE
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1502 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-1718
Mailing Address - Country:US
Mailing Address - Phone:703-548-0122
Mailing Address - Fax:703-548-0133
Practice Address - Street 1:6475 OLD BEULAH ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-3723
Practice Address - Country:US
Practice Address - Phone:703-822-0570
Practice Address - Fax:703-548-0133
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2020-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0618002529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist