Provider Demographics
NPI:1821403528
Name:LONG, ALEXANDER GA LEUNG (OD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GA LEUNG
Last Name:LONG
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 1:1644 GEIST CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2478
Mailing Address - Country:US
Mailing Address - Phone:408-753-0840
Mailing Address - Fax:
Practice Address - Street 1:4401 4TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-2311
Practice Address - Country:US
Practice Address - Phone:206-403-2027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 60631287TX152W00000X
CA14931TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist