Healthcare Provider Details

I. General information

NPI: 1104998145
Provider Name (Legal Business Name): MELANIE N TRUONG-LE DO, OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE NGA TRUONG DO, OD

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 HARRY HINES BLVD FL 6
DALLAS TX
75390-3002
US

IV. Provider business mailing address

5323 HARRY HINES BLVD # MC9057
DALLAS TX
75390-7208
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-2020
  • Fax:
Mailing address:
  • Phone: 214-648-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number278506
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberS8132
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: