Provider Demographics
NPI:1275846503
Name:LE, MELISSA KIM (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:KIM
Last Name:LE
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:3332 PRINCESS ANNE RD STE 611
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-2613
Mailing Address - Country:US
Mailing Address - Phone:757-368-2828
Mailing Address - Fax:757-468-0167
Practice Address - Street 1:1437 SAMS DR STE 101
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4587
Practice Address - Country:US
Practice Address - Phone:757-819-0540
Practice Address - Fax:757-548-2716
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001958152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist