Individual provider Active NPI

Clifford James Leong, O.D.

  • Optometrist
  • Fremont, CA
National Provider Identifier
1851585624
Registry record updated Sep 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
13702 Issued in CA
Practice address
39355 California St
Suite 103
Fremont, CA 94538-1447
Phone
(510) 744-2010
Fax
(510) 744-2015
NPI assigned
Sep 4, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TUV0071931 NY
Optometrist 152W00000X 13702 CA Primary

Addresses

Primary practice location

39355 California St
Suite 103
Fremont, CA 94538-1447

Mailing address

39355 California St
Suite 103
Fremont, CA 94538-1447
Phone (510) 744-2010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111024000547 CA Practitioner - Optometry 4183789282 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fremont Optometric GroupGroup PAC ID 9638118342, 5 clinicians

Practice addresses (Care Compare)

39355 California St
Suite 103
Fremont, CA 94538-1447
Phone (510) 744-2010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007193NYMDMental Health Counselor
TUV0071931NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Fremont Optometric Group Optometrist CurrentSince Sep 11, 2011 Accepting new patients

Locations

39355 California St
Ste 103
Fremont, CA 94538
Phone (510) 744-2010

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316131200000",
    "number": "1851585624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39355 CALIFORNIA ST",
            "address_2": "SUITE 103",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381447",
            "telephone_number": "510-744-2010",
            "fax_number": "510-744-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39355 CALIFORNIA ST",
            "address_2": "SUITE 103",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381447",
            "telephone_number": "510-744-2010",
            "fax_number": "510-744-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEONG",
        "first_name": "CLIFFORD",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-09-04",
        "last_updated": "2011-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV0071931",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

Verify at the official NPI Registry.