Provider Demographics
NPI:1720421928
Name:E OPTOMETRY GROUP, INC.
Entity type:Organization
Organization Name:E OPTOMETRY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:DOAN
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-515-5748
Mailing Address - Street 1:18181 BUTTERFIELD BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-8108
Mailing Address - Country:US
Mailing Address - Phone:408-779-2000
Mailing Address - Fax:408-778-2569
Practice Address - Street 1:18181 BUTTERFIELD BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-8108
Practice Address - Country:US
Practice Address - Phone:408-779-2000
Practice Address - Fax:408-778-2569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT14629-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA118017Medicare PIN