Provider Demographics
NPI:1376595975
Name:TRUONG, ANH THI (OD)
Entity Type:Individual
Prefix:
First Name:ANH
Middle Name:THI
Last Name:TRUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:T
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22578 TOREADOR DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93908-1121
Mailing Address - Country:US
Mailing Address - Phone:562-606-8312
Mailing Address - Fax:
Practice Address - Street 1:1241 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2207
Practice Address - Country:US
Practice Address - Phone:831-424-1242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10558152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASDO105580Medicaid
CAFU881AMedicare PIN