Provider Demographics
NPI:1922076116
Name:DONG-LEONG, DAVIDA J (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVIDA
Middle Name:J
Last Name:DONG-LEONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DAVIDA
Other - Middle Name:
Other - Last Name:DONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2550 W EL CAMINO AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2550 W EL CAMINO AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-3900
Practice Address - Country:US
Practice Address - Phone:916-921-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6433T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU32202Medicare UPIN
CASD0064330Medicare ID - Type Unspecified