Healthcare Provider Details

I. General information

NPI: 1477399285
Provider Name (Legal Business Name): TINA TRAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA SAN DIEGO HEALTHCARE SYSTEM 3350 LA JOLLA VILLAGE DRIVE
SAN DIEGO CA
92161
US

IV. Provider business mailing address

VA SAN DIEGO HEALTHCARE SYSTEM 3350 LA JOLLA VILLAGE DRIVE
SAN DIEGO CA
92161
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax:
Mailing address:
  • Phone: 858-552-8585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36124
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: