Organization
FONTANA OPTOMETRIC GROUP, INC.
Active
Other names
William Wong and Douglas Leo, O.D.
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS J. LEO O.D. (OWNER)
(909) 428-2020
Entity
Organization
Contact information
Practice address
16866 SEVILLE AVE, FONTANA, CA 92335-3561
(909) 350-1524
(909) 350-8546
Mailing address
8381 JUNIPER AVE STE 100, FONTANA, CA 92335-3431
(909) 428-2020
(844) 274-0986
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
02/20/2019
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