Provider Demographics
NPI:1396706644
Name:TOM, JUDY LEE (OD)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:LEE
Last Name:TOM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JUDY
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:6500 HIRABAYASHI DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-4500
Mailing Address - Country:US
Mailing Address - Phone:408-226-8666
Mailing Address - Fax:408-226-2382
Practice Address - Street 1:874C BLOSSOM HILL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2725
Practice Address - Country:US
Practice Address - Phone:408-226-8666
Practice Address - Fax:408-226-2382
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92860T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0092860Medicaid
CASD0092860Medicaid