Provider Demographics
NPI:1962886887
Name:BAILEY, JUSTINE SIMON (OD, FCOVD)
Entity type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:SIMON
Last Name:BAILEY
Suffix:
Gender:F
Credentials:OD, FCOVD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 VILLA LA JOLLA DR STE B128
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1705
Mailing Address - Country:US
Mailing Address - Phone:408-406-7334
Mailing Address - Fax:
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE B128
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1705
Practice Address - Country:US
Practice Address - Phone:408-406-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY56 008342152WV0400X
CA33596152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy