Provider Demographics
NPI:1497052401
Name:LUONG, BRUCE (OD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:LUONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11601 LAGO VIS W
Mailing Address - Street 2:1403
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6806
Mailing Address - Country:US
Mailing Address - Phone:713-503-1207
Mailing Address - Fax:
Practice Address - Street 1:1138 BELT LINE RD
Practice Address - Street 2:230
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-1993
Practice Address - Country:US
Practice Address - Phone:972-495-3997
Practice Address - Fax:972-414-0912
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7606TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist