Provider Demographics
NPI:1033263900
Name:COURTNEY, WA-LEE L (OD)
Entity Type:Individual
Prefix:DR
First Name:WA-LEE
Middle Name:L
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:WA-LEE
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2101 EAST JEFFERSON STREET
Mailing Address - Street 2:KAISER PERMANENTE, PPQA, 6 WEST
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:22033
Mailing Address - Country:US
Mailing Address - Phone:703-934-5905
Mailing Address - Fax:703-934-5778
Practice Address - Street 1:12255 FAIR LAKES PARKWAY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-934-5905
Practice Address - Fax:703-934-5778
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000360152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U22635Medicare UPIN
007040M92Medicare ID - Type Unspecified