Organization
GERONIMO & LEONG, PROFESSIONAL OPTOMETRIC CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOANNA LEONG O.D. (CEO)
(510) 481-2121
Entity
Organization
Contact information
Practice address
15251 E 14TH ST STE B, SAN LEANDRO, CA 94578-1905
(510) 481-2121
(510) 481-2129
Mailing address
15251 E 14TH ST STE B, SAN LEANDRO, CA 94578-1905
(510) 481-2121
(510) 481-2129
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
977
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ26906Z
MEDICARE NSC (PTAN)
CA
Enumeration date
11/20/2006
Last updated
10/08/2009
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