Provider Demographics
NPI:1629649421
Name:LUONG, RICKY TRAN (OD)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:TRAN
Last Name:LUONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2501 TRENTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLE ISLE
Mailing Address - State:FL
Mailing Address - Zip Code:32812-4835
Mailing Address - Country:US
Mailing Address - Phone:407-639-4471
Mailing Address - Fax:
Practice Address - Street 1:1708 LEE RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2160
Practice Address - Country:US
Practice Address - Phone:407-629-1174
Practice Address - Fax:407-629-6117
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist