=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336583442
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DILLINGER AND TRUONG, A PROFESSIONAL OPTOMETRIC CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2013
-----------------------------------------------------
Last Update Date | 04/30/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5701 LONETREE BLVD SUITE 221H
-----------------------------------------------------
City | ROCKLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95765-3772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-626-3003
-----------------------------------------------------
Fax | 916-626-3003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5701 LONETREE BLVD SUITE 221H
-----------------------------------------------------
City | ROCKLIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95765-3772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-626-3003
-----------------------------------------------------
Fax | 916-626-3003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DANIEL L. DILLINGER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 916-626-3003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 12369
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 12289
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------