Provider Demographics
NPI:1124619440
Name:LEON, RONALDO ESAU (OD)
Entity type:Individual
Prefix:DR
First Name:RONALDO
Middle Name:ESAU
Last Name:LEON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 S COULTER ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6676
Mailing Address - Country:US
Mailing Address - Phone:806-358-3594
Mailing Address - Fax:806-457-1660
Practice Address - Street 1:5221 S COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6676
Practice Address - Country:US
Practice Address - Phone:806-358-3594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10272T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist