Provider Demographics
NPI:1669690228
Name:LEUNG, VICKI (OD)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:
Last Name:LEUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23161 VENTURA BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1105
Mailing Address - Country:US
Mailing Address - Phone:818-591-8860
Mailing Address - Fax:
Practice Address - Street 1:23161 VENTURA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1105
Practice Address - Country:US
Practice Address - Phone:818-591-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOP9290T152W00000X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU78992Medicare UPIN
CAOP9290Medicare ID - Type Unspecified