Provider Demographics
NPI:1003808056
Name:TRUONG, NANCY Y (OD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:Y
Last Name:TRUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:T
Other - Last Name:TA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1088 GRASSMEADE CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5501
Mailing Address - Country:US
Mailing Address - Phone:770-330-9250
Mailing Address - Fax:678-212-5622
Practice Address - Street 1:2570 BLACKMON DR STE 350
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6197
Practice Address - Country:US
Practice Address - Phone:678-846-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA306019142AMedicaid
GA52025961OtherBC&BS
GA2200336OtherUNITED HEALTHCARE
GA2200336OtherUNITED HEALTHCARE
GA41ZCFLRMedicare ID - Type Unspecified