Healthcare Provider Details

I. General information

NPI: 1376959395
Provider Name (Legal Business Name): THIEN T TRAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1092 N STATE COLLEGE BLVD
ANAHEIM CA
92806-2701
US

IV. Provider business mailing address

1092 N STATE COLLEGE BLVD
ANAHEIM CA
92806-2701
US

V. Phone/Fax

Practice location:
  • Phone: 714-635-8671
  • Fax: 714-635-9401
Mailing address:
  • Phone: 714-635-8671
  • Fax: 714-635-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number15094TLG
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number15094TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: