Healthcare Provider Details

I. General information

NPI: 1407683063
Provider Name (Legal Business Name): JAEHOON LEE OPTOMETRY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 ALABAMA ST STE B
REDLANDS CA
92374-2067
US

IV. Provider business mailing address

9990 ALABAMA ST STE B
REDLANDS CA
92374-2067
US

V. Phone/Fax

Practice location:
  • Phone: 909-372-0280
  • Fax: 909-372-0156
Mailing address:
  • Phone: 909-372-0280
  • Fax: 909-372-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAEHOON LEE
Title or Position: OWNER
Credential: OD
Phone: 617-233-4847