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General NPI Number Information
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NPI Number | 1184975187
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Entity Type | Individual
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Provider Name | JESSICA LUONG O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 10720 PRESTON RD SUITE 1003
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City | DALLAS
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State | TX
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Zip | 75230-3864
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Country | US
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Telephone | 469-250-0284
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Fax | 469-250-0284
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Provider Business Mailing Address
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Address Line | 189 CARRINGTON LN
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City | LEWISVILLE
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State | TX
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Zip | 75067-6730
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Country | US
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Telephone | 713-503-1591
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Fax | 469-250-0284
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 8024TG
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License Number State | TX
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