Individual provider Active NPI

Nancy Phung Truong

  • Optometrist
  • Tualatin, OR
National Provider Identifier
1457055386
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
ATI4749 Issued in OR
Practice address
7023 SW Nyberg St
Tualatin, OR 97062-6242
Phone
(971) 377-1117
NPI assigned
Mar 27, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X ATI4749 OR Primary

Addresses

Primary practice location

7023 SW Nyberg St
Tualatin, OR 97062-6242

Mailing address

26120 SW Canyon Creek Rd Apt 202
Wilsonville, OR 97070-7640
Phone (503) 510-3021

Other practice location 1

10104 SW Washington Square Rd
Tigard, OR 97223-4457
Phone (503) 968-5437

Other practice location 2

11170 NE Evergreen Pkwy
Beaverton, OR 97006-7522
Phone (503) 617-0963

Other practice location 3

3205 SW Cedar Hills Blvd Ste 9
Beaverton, OR 97005-1347
Phone (503) 646-7995

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240807002867 OR Practitioner - Optometry 8224575238 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Eye Group, PC Optometrist CurrentSince Aug 12, 2024 Accepting new patients

Locations

3205 SW Cedar Hills Blvd
Ste 9
Beaverton, OR 97005
Phone (503) 643-4840

11170 NE Evergreen Pkwy
Beaverton, OR 97006
Phone (503) 617-0963

63455 N Highway 97
Ste 75
Bend, OR 97703
Phone (541) 388-7906

970 NW Eastman Pkwy
Gresham, OR 97030
Phone (503) 666-7460

7023 SW Nyberg St
Tualatin, OR 97062
Phone (971) 377-1117

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1457055386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26120 SW CANYON CREEK RD APT 202",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970707640",
            "telephone_number": "503-510-3021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7023 SW NYBERG ST",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970626242",
            "telephone_number": "971-377-1117"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10104 SW Washington Square Rd",
            "address_purpose": "LOCATION",
            "city": "Tigard",
            "state": "OR",
            "postal_code": "972234457",
            "country_code": "US",
            "telephone_number": "503-968-5437",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11170 NE Evergreen Pkwy",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970067522",
            "country_code": "US",
            "telephone_number": "503-617-0963",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3205 SW Cedar Hills Blvd Ste 9",
            "address_purpose": "LOCATION",
            "city": "Beaverton",
            "state": "OR",
            "postal_code": "970051347",
            "country_code": "US",
            "telephone_number": "503-646-7995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TRUONG",
        "first_name": "NANCY",
        "middle_name": "PHUNG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-27",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "ATI4749",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tualatin, OR

Sources for this page

Verify at the official NPI Registry.