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General NPI Number Information
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NPI Number | 1497901284
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Entity Type | Organization
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Legal Business Name | JENEE S LEE OD INC
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 4637 PINE VALLEY CIR
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City | STOCKTON
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State | CA
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Zip | 95219-1876
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Country | US
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Telephone | 209-479-9811
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Fax |
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Provider Business Mailing Address
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Address Line | 1616 E HAMMER LN
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City | STOCKTON
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State | CA
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Zip | 95210-4119
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | 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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