Provider Demographics
NPI:1154923662
Name:CAO, LOAN TRUC (OD)
Entity type:Individual
Prefix:DR
First Name:LOAN
Middle Name:TRUC
Last Name:CAO
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 1:11438 ELMCREST ST
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-1807
Mailing Address - Country:US
Mailing Address - Phone:626-898-2360
Mailing Address - Fax:
Practice Address - Street 1:3200 LAS VEGAS BLVD S STE 1620
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-0739
Practice Address - Country:US
Practice Address - Phone:702-732-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist