Provider Demographics
NPI:1356093298
Name:Q TRUONG OPTOMETRY CORP
Entity Type:Organization
Organization Name:Q TRUONG OPTOMETRY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/CEO
Authorized Official - Prefix:
Authorized Official - First Name:QUYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-430-8424
Mailing Address - Street 1:8511 TAMBOR WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7217
Mailing Address - Country:US
Mailing Address - Phone:916-430-8424
Mailing Address - Fax:
Practice Address - Street 1:8240 CALVINE RD STE F
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-9310
Practice Address - Country:US
Practice Address - Phone:916-430-8424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA367927Medicaid