=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679948467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRINH FAMILY OPTOMETRIC CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2015
-----------------------------------------------------
Last Update Date | 12/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7119 ELK GROVE BLVD SUITE 123
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95758-9568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-683-5670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7119 ELK GROVE BLVD SUITE 123
-----------------------------------------------------
City | ELK GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95758-9568
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-683-5670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. THANH TRINH
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 916-730-5964
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 13784
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------