Provider Demographics
NPI:1528027273
Name:DO, LONG TRANG (OD)
Entity Type:Individual
Prefix:
First Name:LONG
Middle Name:TRANG
Last Name:DO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N GAREY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2721
Mailing Address - Country:US
Mailing Address - Phone:909-620-5292
Mailing Address - Fax:
Practice Address - Street 1:11471 KATHY LN
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-1716
Practice Address - Country:US
Practice Address - Phone:714-615-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10932T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0109320Medicaid
CAWOP10932KMedicare ID - Type Unspecified