Provider Demographics
NPI:1801051800
Name:LEE, IN AH (OD)
Entity type:Individual
Prefix:DR
First Name:IN
Middle Name:AH
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:INA
Other - Middle Name:
Other - Last Name:LEE-WHARTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:4975 PALMER ROAD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4975 PALMER ROAD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:845-938-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-19
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33025FMedicare PIN
NYVAD000Medicare UPIN