Provider Demographics
NPI:1396864112
Name:LEONG, CLIFFORD G (OD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:G
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 1:18867 ASPESI DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-5209
Mailing Address - Country:US
Mailing Address - Phone:408-254-5171
Mailing Address - Fax:
Practice Address - Street 1:55 E JULIAN ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-4007
Practice Address - Country:US
Practice Address - Phone:408-918-2600
Practice Address - Fax:408-918-2693
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA04760T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist