Provider Demographics
NPI:1689843062
Name:DST GROUP
Entity Type:Organization
Organization Name:DST GROUP
Other - Org Name:TEXAS OPTICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THANH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-482-9992
Mailing Address - Street 1:3670 E FM 528 RD
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5039
Mailing Address - Country:US
Mailing Address - Phone:281-482-9992
Mailing Address - Fax:281-482-9982
Practice Address - Street 1:3670 E FM 528 RD
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5039
Practice Address - Country:US
Practice Address - Phone:281-482-9992
Practice Address - Fax:281-482-9982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y720Medicare PIN