Provider Demographics
NPI:1245478155
Name:TRUONG, BAOTRAM PHUONG (OD)
Entity type:Individual
Prefix:DR
First Name:BAOTRAM
Middle Name:PHUONG
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 1:1030 NORWOOD PARK BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-6606
Mailing Address - Country:US
Mailing Address - Phone:512-491-9707
Mailing Address - Fax:
Practice Address - Street 1:1030 NORWOOD PARK BLVD STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-6606
Practice Address - Country:US
Practice Address - Phone:512-491-9707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7140TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist