Provider Demographics
NPI:1306125505
Name:LEUNG OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:LEUNG OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-303-7509
Mailing Address - Street 1:866 SOUTHGATE AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-3741
Mailing Address - Country:US
Mailing Address - Phone:650-303-7509
Mailing Address - Fax:
Practice Address - Street 1:9000 NORTHGATE MALL
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903
Practice Address - Country:US
Practice Address - Phone:415-507-2364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13996152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty