Individual
DR. DOUGLAS J LEO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
16866 SEVILLE AVE, FONTANA, CA 92335-3561
(909) 350-1524
(909) 350-8546
Mailing address
16866 SEVILLE AVE, P.O. BOX 2020, FONTANA, CA 92335-3561
(909) 350-1524
(909) 350-8546
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
06988
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
YYY48781Y
—
CA
Enumeration date
10/25/2006
Last updated
07/08/2007
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