Active NPI
Evelyn Lee, OD
- Optometrist
- Corona, CA
National Provider Identifier
1073042941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 33678
- Practice address
- 2620 Tuscany St Ste 103
Corona, CA 92881-4646 - Phone
- (951) 372-9623
- NPI assigned
- Jun 5, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 33678 | CA | Primary |
Addresses
Primary practice location
2620 Tuscany St Ste 103
Corona, CA 92881-4646
Mailing address
400 N Acacia Ave Unit D39
Fullerton, CA 92831-4079
Other practice location 1
1 Mills Cir Ste 516
Ontario, CA 91764-5211
Phone (909) 484-9030
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33678 | CA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark a. Jury Optometric Professional Corporation | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Wildomar, CA
- NPI 1033293592
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1073042941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 N ACACIA AVE UNIT D39",
"city": "FULLERTON",
"state": "CA",
"postal_code": "928314079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2620 TUSCANY ST STE 103",
"city": "CORONA",
"state": "CA",
"postal_code": "928814646",
"telephone_number": "951-372-9623"
}
],
"practiceLocations": [
{
"address_1": "1 Mills Cir Ste 516",
"address_purpose": "LOCATION",
"city": "Ontario",
"state": "CA",
"postal_code": "917645211",
"country_code": "US",
"telephone_number": "909-484-9030",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEE",
"first_name": "EVELYN",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-05",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "33678",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.