MEDICARE: DR. LOAN KIM TRAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	SD0114001	CA

General Provider Information

NPI Number	:	1124161112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOAN KIM TRAN O.D.

Provider Business Mailing Address
First Line	:	1282 STABLER LN
Second Line	:	STE. 620
City	:	YUBA CITY
State	:	CA
Zip	:	95993-2625
Country	:	US
Telephone Number	:	530-755-9886
Fax Number	:	530-755-9885

Provider Business Practice Location Address
First Line	:	1282 STABLER LN
Second Line	:	STE. 620
City	:	YUBA CITY
State	:	CA
Zip	:	95993-2625
Country	:	US
Telephone Number	:	530-755-9886
Fax Number	:	530-755-9885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	03/21/2008

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