Provider Demographics
NPI:1962694356
Name:LEE, JOHN YOUNG (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:YOUNG
Last Name:LEE
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 1:219 OLD HOOK RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3131
Mailing Address - Country:US
Mailing Address - Phone:201-664-0847
Mailing Address - Fax:201-664-0847
Practice Address - Street 1:219 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3131
Practice Address - Country:US
Practice Address - Phone:201-664-0847
Practice Address - Fax:201-664-0847
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007224-1152W00000X
NJ27OA00613900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0181234Medicaid