=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972039188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIEU NGA TRUONG & TRA MI TRUONG OPTOMETRY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2017
-----------------------------------------------------
Last Update Date | 05/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9430 WARNER AVE STE M
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-2826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-377-2020
-----------------------------------------------------
Fax | 714-377-2021
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9430 WARNER AVE STE M
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-2826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-377-2020
-----------------------------------------------------
Fax | 714-377-2021
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST/CFO
-----------------------------------------------------
Name | DR. TRA MI THI TRUONG
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 714-507-8222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 9962T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152WC0802X
-----------------------------------------------------
Taxonomy Name | Corneal and Contact Management Optometrist
-----------------------------------------------------
License Number | 10459T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------