Healthcare Provider Details

I. General information

NPI: 1306467071
Provider Name (Legal Business Name): HOAI THI THANH TRAN, OD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15972 EUCLID ST STE G
FOUNTAIN VALLEY CA
92708-1133
US

IV. Provider business mailing address

15972 EUCLID ST STE G
FOUNTAIN VALLEY CA
92708-1133
US

V. Phone/Fax

Practice location:
  • Phone: 714-531-7626
  • Fax: 714-531-7608
Mailing address:
  • Phone: 714-308-5343
  • Fax: 714-531-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. HOAI THI TRAN
Title or Position: OWNER
Credential: OD
Phone: 714-531-7626