Provider Demographics
NPI:1205268976
Name:GARLEY LEON O D PROFESSIONAL OPTOMETRY CORPORATION
Entity type:Organization
Organization Name:GARLEY LEON O D PROFESSIONAL OPTOMETRY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARLEY
Authorized Official - Middle Name:CHENG
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:415-722-6622
Mailing Address - Street 1:100 1ST ST STE 145
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-2668
Mailing Address - Country:US
Mailing Address - Phone:415-777-2020
Mailing Address - Fax:415-777-2030
Practice Address - Street 1:100 FIRST ST
Practice Address - Street 2:SUITE 145
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-2634
Practice Address - Country:US
Practice Address - Phone:415-777-2020
Practice Address - Fax:415-777-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13394152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HM760AMedicare PIN