Provider Demographics
NPI:1851846422
Name:LEE, YOUNG HEE
Entity Type:Individual
Prefix:
First Name:YOUNG HEE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 N ALPINE RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1439
Mailing Address - Country:US
Mailing Address - Phone:815-397-5959
Mailing Address - Fax:815-261-5971
Practice Address - Street 1:1603 N ALPINE RD
Practice Address - Street 2:SUITE 121
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1439
Practice Address - Country:US
Practice Address - Phone:815-397-5959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist