MEDICARE: DR. CUONG N. TRIEU O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	VUT005895	NY

General Provider Information

NPI Number	:	1871690750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CUONG N. TRIEU O.D.

Provider Business Mailing Address
First Line	:	54 WETMORE PARK
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14606-1422
Country	:	US
Telephone Number	:	585-454-4630
Fax Number	:	585-454-4631

Provider Business Practice Location Address
First Line	:	286 EXCHANGE BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14608-2707
Country	:	US
Telephone Number	:	585-454-4630
Fax Number	:	585-454-4631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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