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General NPI Number Information
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NPI Number | 1558654277
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Entity Type | Organization
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Legal Business Name | JAEHOON LEE, OD, INC.,
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Dates
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Enumeration Date | 05/27/2011
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Last Update Date | 05/27/2011
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Provider Practice Location Address
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Address Line | 19179 BEAR VALLEY RD SUITE 10
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City | APPLE VALLEY
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State | CA
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Zip | 92308-2724
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Country | US
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Telephone | 760-240-9679
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Fax | 760-240-8062
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Provider Business Mailing Address
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Address Line | 19179 BEAR VALLEY RD SUITE 10
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City | APPLE VALLEY
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State | CA
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Zip | 92308-2724
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Country | US
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Telephone | 760-240-9679
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Fax | 760-240-8062
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Authorized Official
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Title or Position | CEO
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Name | DR. JAEHOON LEE
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Credential | O.D.
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Telephone | 617-233-4847
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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 | 12239T
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License Number State | CA
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