Provider Demographics
NPI:1386772937
Name:TRA MI THI TRUONG, O.D., INC.
Entity type:Organization
Organization Name:TRA MI THI TRUONG, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TRA MI
Authorized Official - Middle Name:THI
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-402-1895
Mailing Address - Street 1:100 LOS CERRITOS MALL
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5421
Mailing Address - Country:US
Mailing Address - Phone:562-402-1895
Mailing Address - Fax:562-402-0507
Practice Address - Street 1:100 LOS CERRITOS MALL
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5421
Practice Address - Country:US
Practice Address - Phone:562-402-1895
Practice Address - Fax:562-402-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9962T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty