Healthcare Provider Details

I. General information

NPI: 1366607558
Provider Name (Legal Business Name): GRACE TRAN CHI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GRACE TRAN O.D.

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S LAKE AVE STE 111
PASADENA CA
91101
US

IV. Provider business mailing address

350 S LAKE AVE STE 111
PASADENA CA
91101-3553
US

V. Phone/Fax

Practice location:
  • Phone: 626-683-6968
  • Fax:
Mailing address:
  • Phone: 626-683-6868
  • Fax: 626-782-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3347AT
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberTUV007297
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPT13877PLG
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT13877PLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: