Provider Demographics
NPI:1114031259
Name:LEONG, MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LEONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 KIOPAA PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8283
Mailing Address - Country:US
Mailing Address - Phone:808-873-9588
Mailing Address - Fax:
Practice Address - Street 1:8 KIOPAA PL
Practice Address - Street 2:SUITE 102
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8283
Practice Address - Country:US
Practice Address - Phone:808-873-9588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIOD 627152WC0802X
HIOD-627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIU99307Medicare UPIN