Individual provider Active NPI

Clifford G Leong, O.D.

  • Optometrist
  • San Jose, CA
National Provider Identifier
1396864112
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
04760T Issued in CA
Practice address
55 E Julian St
San Jose, CA 95112-4007
Phone
(408) 918-2600
Fax
(408) 918-2693
NPI assigned
Mar 29, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 04760T CA Primary

Addresses

Primary practice location

55 E Julian St
San Jose, CA 95112-4007

Mailing address

18867 Aspesi Dr
Saratoga, CA 95070-5209
Phone (408) 254-5171

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
04760TCAMDOptometrist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396864112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18867 ASPESI DR",
            "city": "SARATOGA",
            "state": "CA",
            "postal_code": "950705209",
            "telephone_number": "408-254-5171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 E JULIAN ST",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951124007",
            "telephone_number": "408-918-2600",
            "fax_number": "408-918-2693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEONG",
        "first_name": "CLIFFORD",
        "middle_name": "G",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "04760T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.