Provider Demographics
NPI:1568740793
Name:LEE, ERIN (OD)
Entity Type:Individual
Prefix:
First Name:ERIN
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 1:10255 YORK RD
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3201
Mailing Address - Country:US
Mailing Address - Phone:410-666-0610
Mailing Address - Fax:410-666-2146
Practice Address - Street 1:10255 YORK RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3201
Practice Address - Country:US
Practice Address - Phone:410-666-0610
Practice Address - Fax:410-666-2146
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2258152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist