Provider Demographics
NPI:1497108450
Name:LUONG, DORIS (OD)
Entity Type:Individual
Prefix:DR
First Name:DORIS
Middle Name:
Last Name:LUONG
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 1:10500 ULMERTON RD
Mailing Address - Street 2:#278
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3544
Mailing Address - Country:US
Mailing Address - Phone:727-444-0901
Mailing Address - Fax:
Practice Address - Street 1:10500 ULMERTON RD
Practice Address - Street 2:#278
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3544
Practice Address - Country:US
Practice Address - Phone:727-444-0901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 5255152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist