Healthcare Provider Details

I. General information

NPI: 1962470153
Provider Name (Legal Business Name): RICHARD G LEONG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 11/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 916-921-2020
  • Fax: 916-921-2200
Mailing address:
  • Phone: 916-921-2020
  • Fax: 916-921-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6494T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: