Provider Demographics
NPI:1609164128
Name:TRINH, LISA (OD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:TRINH
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 1:4403 BLACK HORSE PIKE
Mailing Address - Street 2:129 HAMILTON MALL
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-3103
Mailing Address - Country:US
Mailing Address - Phone:609-484-0060
Mailing Address - Fax:609-484-0205
Practice Address - Street 1:4403 BLACK HORSE PIKE
Practice Address - Street 2:129 HAMILTON MALL
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-3103
Practice Address - Country:US
Practice Address - Phone:609-484-0060
Practice Address - Fax:609-484-0205
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00632600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist