Healthcare Provider Details

I. General information

NPI: 1104392091
Provider Name (Legal Business Name): VICKI LEUNG, O.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 COCHRAN ST STE D
SIMI VALLEY CA
93065-7902
US

IV. Provider business mailing address

2845 COCHRAN ST STE D
SIMI VALLEY CA
93065-7902
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-6824
  • Fax: 805-527-9247
Mailing address:
  • Phone: 805-527-6824
  • Fax: 805-527-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: VICKI LEUNG
Title or Position: OWNER
Credential: OD
Phone: 805-527-6824