Healthcare Provider Details

I. General information

NPI: 1487400511
Provider Name (Legal Business Name): VANESSA VI-VI TRAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161-2023
US

IV. Provider business mailing address

5300 W 1ST ST APT 54
SANTA ANA CA
92703-3040
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax:
Mailing address:
  • Phone: 714-715-0219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT35967-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: