Provider Demographics
NPI:1316917339
Name:LUQUE, LEE-JIUAN (OD)
Entity type:Individual
Prefix:DR
First Name:LEE-JIUAN
Middle Name:
Last Name:LUQUE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LEE-JIUAN
Other - Middle Name:
Other - Last Name:ONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:29023 MIRADA CIRCULO
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-1591
Mailing Address - Country:US
Mailing Address - Phone:949-726-2842
Mailing Address - Fax:866-926-9833
Practice Address - Street 1:44665 VALLEY CENTRAL WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-6500
Practice Address - Country:US
Practice Address - Phone:661-942-7007
Practice Address - Fax:866-926-9833
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11937TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0119370Medicaid
CAU97047Medicare UPIN