Provider Demographics
NPI:1962415687
Name:LEE, MEA YOUNG (OD)
Entity type:Individual
Prefix:DR
First Name:MEA
Middle Name:YOUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:MEA-YOUNG
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:14270 HOLLY GLEN CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-7011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9405 LIBERIA AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20111
Practice Address - Country:US
Practice Address - Phone:703-257-9676
Practice Address - Fax:703-257-9699
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000401152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist