Individual provider Active NPI

Tiffany Thuy Truong, O.D., F.I.A.O.M.C.

  • Optometrist
  • Fremont, CA
National Provider Identifier
1891817805
Registry record updated Jul 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT 9442 TPA Issued in CA
Practice address
5395 Mowry Ave
Fremont, CA 94538-1057
Phone
(510) 440-9825
Fax
(510) 250-1065
NPI assigned
Apr 3, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT 9442 TPA CA Primary

Addresses

Primary practice location

5395 Mowry Ave
Fremont, CA 94538-1057

Mailing address

5395 Mowry Ave
Fremont, CA 94538-1057
Phone (510) 440-9825

Other identifiers 1

IdentifierTypeStateIssuer
SD0094420MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20041207001275 CA Practitioner - Optometry 6800852211 Practice locations: Fremont, CA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9442CAMDProfessional Counselor
OPT 9442 TPACAMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562112000000",
    "number": "1891817805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5395 MOWRY AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381057",
            "telephone_number": "510-440-9825",
            "fax_number": "510-250-1065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5395 MOWRY AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381057",
            "telephone_number": "510-440-9825",
            "fax_number": "510-250-1065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRUONG",
        "first_name": "TIFFANY",
        "middle_name": "THUY",
        "name_prefix": "Dr.",
        "credential": "O.D., F.I.A.O.M.C.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2019-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 9442 TPA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0094420",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

Verify at the official NPI Registry.