Provider Demographics
NPI:1548418023
Name:TRUONG, HENRY HOAI (OD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:HOAI
Last Name:TRUONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:140 N FREMONT ST
Mailing Address - Street 2:STE # 1
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-4729
Mailing Address - Country:US
Mailing Address - Phone:209-823-3151
Mailing Address - Fax:209-823-3151
Practice Address - Street 1:140 N FREMONT ST
Practice Address - Street 2:STE # 1
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-4729
Practice Address - Country:US
Practice Address - Phone:209-823-3151
Practice Address - Fax:209-823-3151
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13605TPA152W00000X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152W00000XEye and Vision Services ProvidersOptometrist