Healthcare Provider Details

I. General information

NPI: 1366472920
Provider Name (Legal Business Name): JOANNA LEONG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15251 E 14TH ST SUITE B
SAN LEANDRO CA
94578-1905
US

IV. Provider business mailing address

15251 E 14TH ST SUITE B
SAN LEANDRO CA
94578-1905
US

V. Phone/Fax

Practice location:
  • Phone: 510-481-2121
  • Fax:
Mailing address:
  • Phone: 510-481-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number11514T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: