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NPI Code Detail

MEDICARE: JUDITH LEE O.D.

MEDICARE: JUDITH LEE 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
1152W00000XOptometrist15098CA

General Provider Information

NPI Number : 1942615448
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH LEE O.D.
Provider Business Mailing Address
First Line : 4200 E 4TH ST
Second Line :
City : ONTARIO
State : CA
Zip : 91764-5250
Country : US
Telephone Number : 909-285-3108
Fax Number :
Provider Business Practice Location Address
First Line : 4200 E 4TH ST
Second Line :
City : ONTARIO
State : CA
Zip : 91764-5250
Country : US
Telephone Number : 909-285-3108
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2014
Last Update Date : 03/25/2026

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