Provider Demographics
NPI:1740403203
Name:LEONG, MONIQUE WONG (OD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:WONG
Last Name:LEONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1415 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3606
Mailing Address - Country:US
Mailing Address - Phone:580-458-9756
Mailing Address - Fax:
Practice Address - Street 1:1415 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3606
Practice Address - Country:US
Practice Address - Phone:580-458-9756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist