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General NPI Number Information
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NPI Number | 1386772937
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Entity Type | Organization
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Legal Business Name | TRA MI THI TRUONG, O.D., INC.
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 LOS CERRITOS MALL
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City | CERRITOS
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State | CA
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Zip | 90703-5421
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Country | US
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Telephone | 562-402-1895
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Fax | 562-402-0507
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Provider Business Mailing Address
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Address Line | 100 LOS CERRITOS MALL
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City | CERRITOS
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State | CA
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Zip | 90703-5421
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Country | US
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Telephone | 562-402-1895
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Fax | 562-402-0507
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Authorized Official
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Title or Position | CEO
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Name | DR. TRA MI THI TRUONG
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Credential | O.D.
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Telephone | 562-402-1895
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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 | 9962T
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License Number State | CA
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