Healthcare Provider Details

I. General information

NPI: 1982277364
Provider Name (Legal Business Name): DR.JULIANE LEE O.D., PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 S DURANGO DR STE 103
LAS VEGAS NV
89113-2290
US

IV. Provider business mailing address

6225 S DURANGO DR STE 103
LAS VEGAS NV
89113-2290
US

V. Phone/Fax

Practice location:
  • Phone: 725-735-8030
  • Fax: 725-735-8031
Mailing address:
  • Phone: 725-735-8030
  • Fax: 725-735-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: JULIANE LEE
Title or Position: CEO
Credential: CEO
Phone: 562-587-0337