Provider Demographics
NPI:1124025911
Name:LE, THI TRUONG (OD)
Entity Type:Individual
Prefix:DR
First Name:THI
Middle Name:TRUONG
Last Name:LE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:THI
Other - Middle Name:DIEU
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1206 W 38TH ST
Mailing Address - Street 2:1204A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1018
Mailing Address - Country:US
Mailing Address - Phone:512-454-1900
Mailing Address - Fax:512-206-4402
Practice Address - Street 1:1206 W 38TH ST
Practice Address - Street 2:1204A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1018
Practice Address - Country:US
Practice Address - Phone:512-454-1900
Practice Address - Fax:512-206-4402
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6682T152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist