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General NPI Number Information
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NPI Number | 1629649421
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Entity Type | Individual
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Provider Name | RICKY TRAN LUONG OD
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Gender | Male
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 1708 LEE RD
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City | WINTER PARK
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State | FL
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Zip | 32789-2160
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Country | US
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Telephone | 407-629-1174
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Fax | 407-629-6117
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Provider Business Mailing Address
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Address Line | 2501 TRENTWOOD BLVD
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City | BELLE ISLE
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State | FL
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Zip | 32812-4835
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Country | US
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Telephone | 407-639-4471
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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 | OPC5931
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License Number State | FL
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