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General NPI Number Information
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NPI Number | 1932904877
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Entity Type | Organization
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Legal Business Name | JAEHOON LEE MENIFEE OPTOMETRY
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 27830 BRADLEY RD
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City | SUN CITY
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State | CA
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Zip | 92586-2201
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Country | US
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Telephone | 951-672-4971
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Fax |
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Provider Business Mailing Address
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Address Line | 12773 BRIDGE WATER DR
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-9424
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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 | CEO
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Name | DR. JAEHOON LEE
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Credential | OD
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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 |
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License Number State |
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