Provider Demographics
NPI:1376859611
Name:TRUONG, THU THI MONG (OD)
Entity Type:Individual
Prefix:MS
First Name:THU
Middle Name:THI MONG
Last Name:TRUONG
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 1:11651 ROYAL PALM BLVD APT 206
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-6931
Mailing Address - Country:US
Mailing Address - Phone:941-258-7832
Mailing Address - Fax:
Practice Address - Street 1:142 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3433
Practice Address - Country:US
Practice Address - Phone:941-258-7832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001970152W00000X
FLOPC 4545152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist