Healthcare Provider Details

I. General information

NPI: 1538296322
Provider Name (Legal Business Name): CHRISTINE H TRUONG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 12/02/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 SHADOWRIDGE DR
VISTA CA
92083-7986
US

IV. Provider business mailing address

780 SHADOWRIDGE DR
VISTA CA
92083-7986
US

V. Phone/Fax

Practice location:
  • Phone: 760-599-2210
  • Fax:
Mailing address:
  • Phone: 585-227-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV007240
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13054TPA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: