Provider Demographics
NPI:1033653449
Name:TAN TRUONG OD INC
Entity Type:Organization
Organization Name:TAN TRUONG OD INC
Other - Org Name:IMAGINE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD, MPH, PHD
Authorized Official - Phone:510-717-4462
Mailing Address - Street 1:3860 FALLON RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4277
Mailing Address - Country:US
Mailing Address - Phone:510-717-4462
Mailing Address - Fax:
Practice Address - Street 1:3860 FALLON RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-4277
Practice Address - Country:US
Practice Address - Phone:510-717-4462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty