Healthcare Provider Details

I. General information

NPI: 1295309003
Provider Name (Legal Business Name): REBECCA TRUONG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 05/06/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8136 OLD KEENE MILL RD STE B300
SPRINGFIELD VA
22152-1856
US

IV. Provider business mailing address

8136 OLD KEENE MILL RD STE B300
SPRINGFIELD VA
22152-1856
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-5275
  • Fax:
Mailing address:
  • Phone: 703-451-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003094
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: