MEDICARE: ROXANNE MUGUAN LEE-LOUIE O.D.

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	6492	CA

General Provider Information

NPI Number	:	1598855652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANNE MUGUAN LEE-LOUIE O.D.

Provider Business Mailing Address
First Line	:	9 COBBLELAKE CT
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-4319
Country	:	US
Telephone Number	:	916-392-8524
Fax Number	:	916-392-8524

Provider Business Practice Location Address
First Line	:	9098 LAGUNA MAIN ST
Second Line	:	SUITE 3
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7449
Country	:	US
Telephone Number	:	916-691-2020
Fax Number	:	916-691-2330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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