Healthcare Provider Details

I. General information

NPI: 1134425747
Provider Name (Legal Business Name): SERENA M LEUNG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 08/14/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 N SARATOGA ST
OAK HARBOR WA
98278-4908
US

IV. Provider business mailing address

480 CENTRAL AVE
JBPHH HI
96860-4908
US

V. Phone/Fax

Practice location:
  • Phone: 360-257-6264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberOD-784
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD-784
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: