Healthcare Provider Details

I. General information

NPI: 1922076116
Provider Name (Legal Business Name): DAVIDA J DONG-LEONG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAVIDA DONG O.D.

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W EL CAMINO AVE SUITE 11
SACRAMENTO CA
95833-3900
US

IV. Provider business mailing address

2550 W EL CAMINO AVE SUITE 11
SACRAMENTO CA
95833-3900
US

V. Phone/Fax

Practice location:
  • Phone: 916-921-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6433T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: