Provider Demographics
NPI:1114099157
Name:LEONARD, KALI JAVON (OD)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:JAVON
Last Name:LEONARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KALI
Other - Middle Name:JAVON
Other - Last Name:WEIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:6035 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677
Mailing Address - Country:US
Mailing Address - Phone:916-632-8336
Mailing Address - Fax:
Practice Address - Street 1:421 B PIONEER AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776
Practice Address - Country:US
Practice Address - Phone:530-661-0300
Practice Address - Fax:530-661-0501
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 12887T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0128870Medicaid
CASD0128870Medicaid
CASD0128870Medicaid