Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD-627 | HI |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OD 627 | HI |
NPI | 1114031259 |
---|---|
Provider Name | Dr. Michael Leong |
First Address | Makawao, HI 96768-8283 |
Second Address | Makawao, HI 96768-8283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 06/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U99307 | (02) | HI |