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General NPI Number Information
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NPI Number | 1093247223
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Entity Type | Organization
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Legal Business Name | JENEE LEE OD PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 07/21/2023
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Provider Practice Location Address
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Address Line | 480 N MCKINLEY ST
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City | CORONA
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State | CA
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Zip | 92879-1291
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Country | US
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Telephone | 951-279-1987
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Fax | 951-279-8355
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Provider Business Mailing Address
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Address Line | 28 BLUEJAY
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City | IRVINE
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State | CA
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Zip | 92604-3266
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Country | US
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Telephone | 209-479-9811
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Fax |
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Authorized Official
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Title or Position | CEO/OPTOMETRIST
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Name | JENEE S LEE
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Credential | OD
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Telephone | 209-479-9811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13397T
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License Number State | CA
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