Provider Demographics
NPI:1295929370
Name:LEE, JENEE SUZANNE (OD)
Entity type:Individual
Prefix:DR
First Name:JENEE
Middle Name:SUZANNE
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 1:28 BLUEJAY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3266
Mailing Address - Country:US
Mailing Address - Phone:209-479-9811
Mailing Address - Fax:
Practice Address - Street 1:480 N MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-1291
Practice Address - Country:US
Practice Address - Phone:951-279-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13397152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist