Provider Demographics
NPI:1811301401
Name:TSE, JULIE (OD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:TSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1617 SAINT MARKS PLZ
Mailing Address - Street 2:SUITE D
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6423
Mailing Address - Country:US
Mailing Address - Phone:209-478-1797
Mailing Address - Fax:209-478-1224
Practice Address - Street 1:1617 SAINT MARKS PLZ
Practice Address - Street 2:SUITE D
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6423
Practice Address - Country:US
Practice Address - Phone:209-478-1797
Practice Address - Fax:209-478-1224
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOPT 14964 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist