=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629126370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VAN THUY TRUONG, OD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2007
-----------------------------------------------------
Last Update Date | 05/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 MEMORIAL CITY STE 628
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77024-2689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-461-4448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 MEMORIAL CITY STE 628
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77024-2689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-461-4448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. VAN THUY TRUONG
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 713-461-4448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 5602TG
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------