=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508144353
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HIEN TRINH O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2011
-----------------------------------------------------
Last Update Date | 07/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7119 ELK GROVE BLVD STE 123
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95758-9568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-683-5670
-----------------------------------------------------
Fax | 916-684-2807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7119 ELK GROVE BLVD STE 123
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95758-9568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 14140
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 007903
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------