Provider Demographics
NPI:1629533518
Name:LEUNG, FREDERICK THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:THOMAS
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 1:27 PEBBLE RD
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-4317
Mailing Address - Country:US
Mailing Address - Phone:781-620-0305
Mailing Address - Fax:
Practice Address - Street 1:27 PEBBLE RD
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-4317
Practice Address - Country:US
Practice Address - Phone:781-620-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4147152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist