MEDICARE: DR ASHLEY SUPLEE OD OPTOMETRIC CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1316715212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR ASHLEY SUPLEE OD OPTOMETRIC CORPORATION

Provider Business Mailing Address
First Line	:	3297 ARLINGTON AVE STE 105
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3250
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3297 ARLINGTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-3249
Country	:	US
Telephone Number	:	951-567-3067
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ASHLEY ELIZABETH SUPLEE
Credential	:	OD
Telephone Number	:	951-567-3067

Provider Enumeration Date	:	12/20/2023
Last Update Date	:	06/25/2024

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