Provider Demographics
NPI:1538210562
Name:TRUONG, DIANE (OD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:TRUONG
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 1:200 E VIA RANCHO PKWY STE 289
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-8012
Mailing Address - Country:US
Mailing Address - Phone:760-741-9767
Mailing Address - Fax:760-741-9097
Practice Address - Street 1:200 E VIA RANCHO PKWY STE 289
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-8012
Practice Address - Country:US
Practice Address - Phone:760-741-9767
Practice Address - Fax:760-741-9097
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11966152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU92491Medicare UPIN
CAWOP11966Medicare ID - Type Unspecified