Provider Demographics
NPI:1982277364
Name:DR.JULIANE LEE O.D., PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR.JULIANE LEE O.D., PROFESSIONAL CORPORATION
Other - Org Name:DR.JULIANE LEE O.D.,PROFESSIONAL CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:562-587-0337
Mailing Address - Street 1:6225 S DURANGO DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2290
Mailing Address - Country:US
Mailing Address - Phone:725-735-8030
Mailing Address - Fax:725-735-8031
Practice Address - Street 1:6225 S DURANGO DR STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2290
Practice Address - Country:US
Practice Address - Phone:725-735-8030
Practice Address - Fax:725-735-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-22
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA851824693OtherNA