Provider Demographics
NPI:1831139468
Name:TRUONG, THANH (OD)
Entity Type:Individual
Prefix:DR
First Name:THANH
Middle Name:
Last Name:TRUONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2406 GENTLE BROOK CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-3235
Mailing Address - Country:US
Mailing Address - Phone:832-372-2707
Mailing Address - Fax:
Practice Address - Street 1:1615 S LOOP W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4814
Practice Address - Country:US
Practice Address - Phone:713-795-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6789T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F7307Medicare PIN