Provider Demographics
NPI:1215188255
Name:ROBERTSON, LEE WILLIAM (OD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:WILLIAM
Last Name:ROBERTSON
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 1:204 W SPOTSWOOD TRAIL
Mailing Address - Street 2:ELKTON EYECARE
Mailing Address - City:ELKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22827
Mailing Address - Country:US
Mailing Address - Phone:540-298-1671
Mailing Address - Fax:540-298-1464
Practice Address - Street 1:204 W SPOTSWOOD TRAIL
Practice Address - Street 2:ELKTON EYECARE
Practice Address - City:ELKTON
Practice Address - State:VA
Practice Address - Zip Code:22827
Practice Address - Country:US
Practice Address - Phone:540-298-1671
Practice Address - Fax:540-298-1464
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV628152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA267Medicare PIN