Provider Demographics
NPI:1366472920
Name:LEONG, JOANNA (OD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:
Last Name:LEONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15251 E 14TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1905
Mailing Address - Country:US
Mailing Address - Phone:510-481-2121
Mailing Address - Fax:
Practice Address - Street 1:15251 E 14TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1905
Practice Address - Country:US
Practice Address - Phone:510-481-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11514T152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU86821Medicare UPIN