Provider Demographics
NPI:1407976186
Name:TRUONG, THOMAS HUYNH (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HUYNH
Last Name:TRUONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1865 LAKOTA ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-0235
Mailing Address - Country:US
Mailing Address - Phone:818-771-2177
Mailing Address - Fax:818-772-2067
Practice Address - Street 1:10176 MASON AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3301
Practice Address - Country:US
Practice Address - Phone:818-701-0399
Practice Address - Fax:818-772-2067
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10788T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist