Healthcare Provider Details

I. General information

NPI: 1316715212
Provider Name (Legal Business Name): DR ASHLEY SUPLEE OD OPTOMETRIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 06/25/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3297 ARLINGTON AVE
RIVERSIDE CA
92506-3249
US

IV. Provider business mailing address

3297 ARLINGTON AVE STE 105
RIVERSIDE CA
92506-3250
US

V. Phone/Fax

Practice location:
  • Phone: 951-567-3067
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ASHLEY ELIZABETH SUPLEE
Title or Position: PRESIDENT
Credential: OD
Phone: 951-567-3067