Provider Demographics
NPI:1619379278
Name:LEE, RACHEL JOSLYN (OD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:JOSLYN
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1741 EASTLAKE PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-2032
Mailing Address - Country:US
Mailing Address - Phone:775-762-6364
Mailing Address - Fax:
Practice Address - Street 1:1741 EASTLAKE PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-2032
Practice Address - Country:US
Practice Address - Phone:775-762-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV814152W00000X
CA14986152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist