Provider Demographics
NPI:1760527311
Name:TRUONG, TRA MI THI (OD)
Entity Type:Individual
Prefix:DR
First Name:TRA MI
Middle Name:THI
Last Name:TRUONG
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 1:9430 WARNER AVE STE M
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2826
Mailing Address - Country:US
Mailing Address - Phone:714-377-2020
Mailing Address - Fax:714-377-2021
Practice Address - Street 1:9430 WARNER AVE STE M
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708
Practice Address - Country:US
Practice Address - Phone:714-377-2020
Practice Address - Fax:714-377-2021
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA9962T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management