Provider Demographics
NPI:1093703118
Name:LEE, JULIE KNABEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:KNABEL
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:711 N MAIN ST
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-0209
Mailing Address - Country:US
Mailing Address - Phone:715-425-7235
Mailing Address - Fax:715-425-2140
Practice Address - Street 1:711 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-3502
Practice Address - Country:US
Practice Address - Phone:715-425-7235
Practice Address - Fax:715-425-2140
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2759 035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38616300Medicaid
WI38616300Medicaid
U77704Medicare UPIN
WI38616300Medicaid