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General NPI Number Information
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NPI Number | 1497052401
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Entity Type | Individual
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Provider Name | BRUCE LUONG O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 1138 BELT LINE RD 230
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City | GARLAND
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State | TX
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Zip | 75040-1993
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Country | US
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Telephone | 972-495-3997
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Fax | 972-414-0912
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Provider Business Mailing Address
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Address Line | 11601 LAGO VIS W 1403
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City | FARMERS BRANCH
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State | TX
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Zip | 75234-6806
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Country | US
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Telephone | 713-503-1207
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Fax |
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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 | 7606TG
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License Number State | TX
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