Provider Demographics
NPI:1104998145
Name:TRUONG-LE, MELANIE N (DO, OD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:N
Last Name:TRUONG-LE
Suffix:
Gender:F
Credentials:DO, OD
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:NGA
Other - Last Name:TRUONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO, OD
Mailing Address - Street 1:5323 HARRY HINES BLVD # MC9057
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-7208
Mailing Address - Country:US
Mailing Address - Phone:214-648-3848
Mailing Address - Fax:
Practice Address - Street 1:5303 HARRY HINES BLVD FL 6
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-3002
Practice Address - Country:US
Practice Address - Phone:214-645-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA278506207WX0109X
TXS8132207WX0109X
IADO-05208207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000070FAOtherBLUE CROSS BLUE SHIELD
TX00000070FAOtherBLUE CROSS BLUE SHIELD
TX00000070FAOtherBLUE CROSS BLUE SHIELD