Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 11914T | CA |
NPI | 1003968249 |
---|---|
Provider Name | Mary Leong |
First Address | Antioch, CA 94531-8687 |
Second Address | Antioch, CA 94531-8687 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 03/01/2022 |