Provider Demographics
NPI:1902938368
Name:LEE, JUDY Y M (OD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:Y M
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SUNRISE MALL
Mailing Address - Street 2:VISION CENTER
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4340
Mailing Address - Country:US
Mailing Address - Phone:516-799-5261
Mailing Address - Fax:
Practice Address - Street 1:25121 JAMAICA # 2027
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-2218
Practice Address - Country:US
Practice Address - Phone:718-807-3515
Practice Address - Fax:516-488-2003
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist