MEDICARE: JOEY P TRAN O D INC

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

General Provider Information

NPI Number	:	1225794977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOEY P TRAN O D INC

Provider Business Mailing Address
First Line	:	2980 DAVIDWOOD WAY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95148-2622
Country	:	US
Telephone Number	:	408-826-9868
Fax Number	:

Provider Business Practice Location Address
First Line	:	618 BLOSSOM HILL RD STE 100
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-3048
Country	:	US
Telephone Number	:	408-578-2020
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JOEY TRAN
Credential	:	OD
Telephone Number	:	408-826-9868

Provider Enumeration Date	:	11/16/2021
Last Update Date	:	05/31/2022

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