Basic Information
| Provider Information | |||||||||
| NPI: | 1295855484 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRUONG | ||||||||
| FirstName: | LE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956785134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167844185 | ||||||||
| FaxNumber: | 8777384262 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 RIVERSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956785134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167844185 | ||||||||
| FaxNumber: | 8777384262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 12369T | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.