Provider Demographics
NPI:1740475870
Name:BETETA, NHU TRUONG (OD)
Entity type:Individual
Prefix:
First Name:NHU
Middle Name:TRUONG
Last Name:BETETA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NHU
Other - Middle Name:QUYNH
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:305-628-6117
Mailing Address - Fax:
Practice Address - Street 1:5961 NW 173RD DR
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015
Practice Address - Country:US
Practice Address - Phone:305-556-7500
Practice Address - Fax:305-851-5708
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4391152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist