Provider Demographics
NPI:1851529846
Name:LEE, JANE J (OD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:J
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 1:15 CHARLES PLZ
Mailing Address - Street 2:STE #202
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3989
Mailing Address - Country:US
Mailing Address - Phone:410-717-8131
Mailing Address - Fax:
Practice Address - Street 1:1130 CONNECTICUT AVE NW
Practice Address - Street 2:#110
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3904
Practice Address - Country:US
Practice Address - Phone:202-331-1423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2224152W00000X
390200000X
DCOP1000207152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program