Provider Demographics
NPI:1144374885
Name:LEE, YALING (OD)
Entity type:Individual
Prefix:DR
First Name:YALING
Middle Name:
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 1:1507 HERSHBERGER RD NW STE C
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-7300
Mailing Address - Country:US
Mailing Address - Phone:540-362-1030
Mailing Address - Fax:
Practice Address - Street 1:1507 HERSHBERGER RD NW STE C
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-7300
Practice Address - Country:US
Practice Address - Phone:540-362-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1347-481T152W00000X
VA0618002009152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184679052Medicaid