Provider Demographics
NPI:1184975187
Name:LUONG, JESSICA (OD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LUONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:189 CARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6730
Mailing Address - Country:US
Mailing Address - Phone:713-503-1591
Mailing Address - Fax:469-250-0284
Practice Address - Street 1:10720 PRESTON RD
Practice Address - Street 2:SUITE 1003
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3864
Practice Address - Country:US
Practice Address - Phone:469-250-0284
Practice Address - Fax:469-250-0284
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8024TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist