Provider Demographics
NPI:1609849223
Name:LEE, JOHN HYUP (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HYUP
Last Name:LEE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 OLD YORK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-4611
Mailing Address - Country:US
Mailing Address - Phone:215-935-6908
Mailing Address - Fax:215-935-6387
Practice Address - Street 1:947 OLD YORK RD STE 1
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-4611
Practice Address - Country:US
Practice Address - Phone:215-935-6908
Practice Address - Fax:215-935-6387
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000524152W00000X, 152WC0802X, 152WP0200X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA367529OtherHIGHMARK BLUE SHIELD GROU
PA2017197OtherAETNA - GROUP NUMBER
PA5914492OtherAETNA - INDIVIDUAL
PA785692OtherHIGHMARK BLUE SHIELD INDI
PA367529OtherHIGHMARK BLUE SHIELD GROU
PAU57284Medicare UPIN
PA785692TEEMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL