Individual
SUSAN LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DR.
Contact information
Practice address
14391 CHANTILLY CROSSING LN, CHANTILLY, VA 20151-2118
(703) 817-0748
(703) 817-0748
Mailing address
12527 CERROMAR PL, FAIRFAX, VA 22030-6653
(703) 338-8444
(703) 817-0748
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618002157
VA
152W00000X
Optometrist
TA2308
MD
Other
Enumeration date
07/09/2012
Last updated
02/22/2023
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