Provider Demographics
NPI:1518140896
Name:DR. JAY J. LEE & ASSOCIATES
Entity type:Organization
Organization Name:DR. JAY J. LEE & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:703-368-5557
Mailing Address - Street 1:14270 HOLLY GLEN CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-7011
Mailing Address - Country:US
Mailing Address - Phone:703-368-5557
Mailing Address - Fax:703-368-6522
Practice Address - Street 1:8386 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3428
Practice Address - Country:US
Practice Address - Phone:703-368-5557
Practice Address - Fax:703-368-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA06118001147152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01851Medicare PIN