Provider Demographics
NPI:1417397639
Name:LEUNG, JAMIE (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:LEUNG
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 1:5100 CENTURY AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-5714
Mailing Address - Country:US
Mailing Address - Phone:269-743-2313
Mailing Address - Fax:269-743-2314
Practice Address - Street 1:5100 CENTURY AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-5714
Practice Address - Country:US
Practice Address - Phone:269-743-2313
Practice Address - Fax:269-743-2314
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004776152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist