MEDICARE: DR. KATHY 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	OPT 12865	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPT 12865	OTHER	CA	BOARD OF OPTO. LICENSE

General Provider Information

NPI Number	:	1346355401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHY TRAN O.D.

Provider Business Mailing Address
First Line	:	200 MINOR HL
Second Line	:	UC BERKELEY SCHOOL OF OPTOMETRY
City	:	BERKELEY
State	:	CA
Zip	:	94720-2020
Country	:	US
Telephone Number	:	510-642-2020
Fax Number	:	510-643-3796

Provider Business Practice Location Address
First Line	:	200 MINOR HL
Second Line	:	UC BERKELEY SCHOOL OF OPTOMETRY
City	:	BERKELEY
State	:	CA
Zip	:	94720-2020
Country	:	US
Telephone Number	:	510-642-2020
Fax Number	:	510-643-3796

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	03/16/2015

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