Provider Demographics
NPI:1649392754
Name:PENA, JULENE TINA (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:JULENE
Middle Name:TINA
Last Name:PENA
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 11TH ST NW APT 201
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4317
Mailing Address - Country:US
Mailing Address - Phone:240-737-5160
Mailing Address - Fax:
Practice Address - Street 1:6200 BALTIMORE AVENE
Practice Address - Street 2:SUITE 100
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737
Practice Address - Country:US
Practice Address - Phone:240-737-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2029152WL0500X
CA12343T152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation