Provider Demographics
NPI:1083204754
Name:LEONARD, RUTH BEHAM
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:BEHAM
Last Name:LEONARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 LYON CIR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518-2628
Mailing Address - Country:US
Mailing Address - Phone:415-205-4704
Mailing Address - Fax:
Practice Address - Street 1:323 GEARY ST STE 704
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1816
Practice Address - Country:US
Practice Address - Phone:415-205-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL3138156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist