Healthcare Provider Details

I. General information

NPI: 1225794977
Provider Name (Legal Business Name): JOEY P TRAN O D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 BLOSSOM HILL RD STE 100
SAN JOSE CA
95123-3048
US

IV. Provider business mailing address

2980 DAVIDWOOD WAY
SAN JOSE CA
95148-2622
US

V. Phone/Fax

Practice location:
  • Phone: 408-578-2020
  • Fax:
Mailing address:
  • Phone: 408-826-9868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOEY TRAN
Title or Position: MANAGER
Credential: OD
Phone: 408-826-9868