Provider Demographics
NPI:1093247223
Name:JENEE LEE OD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JENEE LEE OD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JENEE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:209-479-9811
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:951-279-8355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13397T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty