Provider Demographics
NPI:1225559362
Name:TRUONG, BRYAN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:TRUONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 HAMMOND DR UNIT 73
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5476
Mailing Address - Country:US
Mailing Address - Phone:901-652-1760
Mailing Address - Fax:
Practice Address - Street 1:880 CRESTMARK DR STE 101
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2646
Practice Address - Country:US
Practice Address - Phone:770-948-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist