Provider Demographics
NPI:1659412377
Name:LY, KATHERINE YUEH-MEI (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:YUEH-MEI
Last Name:LY
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 1:1347 LAMBERTON DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3415
Mailing Address - Country:US
Mailing Address - Phone:301-754-1347
Mailing Address - Fax:301-754-1350
Practice Address - Street 1:1347 LAMBERTON DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3415
Practice Address - Country:US
Practice Address - Phone:301-754-1347
Practice Address - Fax:301-754-1350
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1736152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDTA1736OtherOPTOMETRIST LICENSE
MD142455ZCFWMedicare PIN