Provider Demographics
NPI:1285986927
Name:TRAN, TRUC LY NGUYEN (OD)
Entity type:Individual
Prefix:DR
First Name:TRUC LY
Middle Name:NGUYEN
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TRUC LY
Other - Middle Name:T
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1027 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-8186
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:714 HIGHWAY ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-1508
Practice Address - Country:US
Practice Address - Phone:336-427-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2345152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist