Provider Demographics
NPI:1922529304
Name:LEE, JUNA ABAZI (OD)
Entity Type:Individual
Prefix:
First Name:JUNA
Middle Name:ABAZI
Last Name:LEE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JUNA
Other - Middle Name:
Other - Last Name:ABAZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5802 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4050
Mailing Address - Country:US
Mailing Address - Phone:414-955-2020
Mailing Address - Fax:414-955-6300
Practice Address - Street 1:5802 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4050
Practice Address - Country:US
Practice Address - Phone:414-955-2020
Practice Address - Fax:414-955-6300
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017020392152W00000X
WI3584152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1922529304Medicaid