Provider Demographics
NPI:1740258979
Name:LEROY, DENNIS HENRY (OD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:HENRY
Last Name:LEROY
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 1:25236 ARCARDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-581-2371
Mailing Address - Fax:
Practice Address - Street 1:26902 OSO PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-582-7776
Practice Address - Fax:949-582-0376
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4099T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0040990Medicare ID - Type Unspecified
T09562Medicare UPIN