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General NPI Number Information
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NPI Number | 1285203851
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Entity Type | Organization
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Legal Business Name | DR.J LEE, OPTOMETRIST , A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/18/2021
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 5100 ORANGETHORPE AVE STE B
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City | LA PALMA
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State | CA
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Zip | 90623-1187
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Country | US
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Telephone | 562-246-9399
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Fax | 562-246-9398
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Provider Business Mailing Address
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Address Line | 5100 ORANGETHORPE AVE STE B
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City | LA PALMA
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State | CA
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Zip | 90623-1187
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Country | US
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Telephone | 562-246-9399
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Fax | 562-246-9398
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Authorized Official
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Title or Position | CEO
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Name | JULIANE LEE
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Credential | OD
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Telephone | 562-587-0337
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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 |
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License Number State |
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