Provider Demographics
NPI:1962470153
Name:LEONG, RICHARD G (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:G
Last Name:LEONG
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 1:2550 W EL CAMINO AVE
Mailing Address - Street 2:STE 11
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3900
Mailing Address - Country:US
Mailing Address - Phone:916-921-2020
Mailing Address - Fax:916-921-2200
Practice Address - Street 1:2550 W EL CAMINO AVE
Practice Address - Street 2:STE 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:916-921-2200
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6494T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0600640001Medicare NSC
CAT10339Medicare UPIN
CASD0064940Medicare ID - Type Unspecified