Provider Demographics
NPI:1336209733
Name:LEM, JEFFREY W (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:LEM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 KEARNY ST.
Mailing Address - Street 2:STE. 52
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108
Mailing Address - Country:US
Mailing Address - Phone:415-956-8498
Mailing Address - Fax:415-781-3615
Practice Address - Street 1:120 KEARNY ST.
Practice Address - Street 2:STE. 52
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108
Practice Address - Country:US
Practice Address - Phone:415-956-8498
Practice Address - Fax:415-781-3615
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8382152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU33173Medicare UPIN
CASD0083820Medicare ID - Type Unspecified