Provider Demographics
NPI:1750720280
Name:TRUONG, TINA DOAN (OD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:DOAN
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 1:18181 BUTTERFIELD BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-8112
Mailing Address - Country:US
Mailing Address - Phone:408-202-4110
Mailing Address - Fax:408-778-2569
Practice Address - Street 1:18181 BUTTERFIELD BLVD STE 150
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-8112
Practice Address - Country:US
Practice Address - Phone:408-779-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14629152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA109386OtherMEDICARE