Provider Demographics
NPI:1154606952
Name:LEONG, DAVID RICHARD (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
Last Name:LEONG
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 1:2550 W EL CAMINO AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3900
Mailing Address - Country:US
Mailing Address - Phone:916-921-2020
Mailing Address - Fax:
Practice Address - Street 1:2550 W EL CAMINO AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-3900
Practice Address - Country:US
Practice Address - Phone:916-921-2020
Practice Address - Fax:916-921-2200
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14321152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist