Healthcare Provider Details

I. General information

NPI: 1780890749
Provider Name (Legal Business Name): JULIANE LEE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2572 ATLANTIC AVE
LONG BEACH CA
90806
US

IV. Provider business mailing address

100 E CALIFORNIA BLVD
PASADENA CA
91105-3205
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-0931
  • Fax:
Mailing address:
  • Phone: 800-898-2020
  • Fax: 626-577-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12165T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: