Provider Demographics
NPI:1588853840
Name:TRUONG, PRISCILLA C (O D)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:C
Last Name:TRUONG
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E DEL MAR BLVD
Mailing Address - Street 2:201
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2567
Mailing Address - Country:US
Mailing Address - Phone:626-354-7313
Mailing Address - Fax:
Practice Address - Street 1:115 E DEL MAR BLVD
Practice Address - Street 2:201
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2567
Practice Address - Country:US
Practice Address - Phone:626-354-7313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13158152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist