Provider Demographics
NPI:1962513465
Name:LEAN, JOHN S (M D F R C S)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:LEAN
Suffix:
Gender:M
Credentials:M D F R C S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23521 PASEO DE VALENCIA
Mailing Address - Street 2:#207
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3107
Mailing Address - Country:US
Mailing Address - Phone:949-707-5125
Mailing Address - Fax:949-707-5129
Practice Address - Street 1:23521 PASEO DE VALENCIA
Practice Address - Street 2:#207
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3107
Practice Address - Country:US
Practice Address - Phone:949-707-5125
Practice Address - Fax:949-707-5129
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41624207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A416241Medicaid
CA00A416241Medicaid
CAA41624AMedicare ID - Type Unspecified