Provider Demographics
NPI:1275576324
Name:TRINH, PHUONG DOAN (OD)
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:DOAN
Last Name:TRINH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5819
Mailing Address - Country:US
Mailing Address - Phone:508-875-9636
Mailing Address - Fax:508-875-3770
Practice Address - Street 1:545 UNION AVE
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-5819
Practice Address - Country:US
Practice Address - Phone:508-875-9636
Practice Address - Fax:508-875-3770
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002678152W00000X
MA4545152W00000X
MAOPT4545152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA 4545OtherEYEMED
MA53944OtherDAVIS VISION
MA0708844Medicaid
MA132152OtherAETNA