Healthcare Provider Details

I. General information

NPI: 1093247223
Provider Name (Legal Business Name): JENEE LEE OD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 N MCKINLEY ST
CORONA CA
92879-1291
US

IV. Provider business mailing address

28 BLUEJAY
IRVINE CA
92604-3266
US

V. Phone/Fax

Practice location:
  • Phone: 951-279-1987
  • Fax: 951-279-8355
Mailing address:
  • Phone: 209-479-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13397T
License Number StateCA

VIII. Authorized Official

Name: JENEE S LEE
Title or Position: CEO/OPTOMETRIST
Credential: OD
Phone: 209-479-9811