Healthcare Provider Details

I. General information

NPI: 1205403474
Provider Name (Legal Business Name): AMANDA TRAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1066 S WHITE RD STE 170
SAN JOSE CA
95127-3812
US

IV. Provider business mailing address

3487 VALLEY VISTA DR
SAN JOSE CA
95148-2176
US

V. Phone/Fax

Practice location:
  • Phone: 408-729-9700
  • Fax: 408-574-0175
Mailing address:
  • Phone: 408-824-0749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: