Provider Demographics
NPI:1528166154
Name:AU, DUC TRUONG (OD)
Entity type:Individual
Prefix:
First Name:DUC
Middle Name:TRUONG
Last Name:AU
Suffix:
Gender:M
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:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-0806
Mailing Address - Country:US
Mailing Address - Phone:703-534-8111
Mailing Address - Fax:703-241-4522
Practice Address - Street 1:444 W. BROAD STREET
Practice Address - Street 2:SUITE N
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3344
Practice Address - Country:US
Practice Address - Phone:703-534-8111
Practice Address - Fax:703-241-4522
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12785TPA152W00000X
VA0618001189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist