Provider Demographics
NPI:1770954323
Name:TRUONG, DIANA YEN XUAN (OD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:YEN XUAN
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 1:4060 SPRING VALLEY RD APT 103
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3820
Mailing Address - Country:US
Mailing Address - Phone:916-743-2697
Mailing Address - Fax:
Practice Address - Street 1:150 E STACY RD
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-8756
Practice Address - Country:US
Practice Address - Phone:469-786-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8809T152W00000X
TX8809TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist