Healthcare Provider Details

I. General information

NPI: 1932787520
Provider Name (Legal Business Name): TRAM LE OD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 TIOGA AVE
SAND CITY CA
93955-3050
US

IV. Provider business mailing address

801 TIOGA AVE
SAND CITY CA
93955-3050
US

V. Phone/Fax

Practice location:
  • Phone: 916-616-5165
  • Fax:
Mailing address:
  • Phone: 916-616-5165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TRAM LE
Title or Position: OPTOMETRIST
Credential: OD
Phone: 916-616-5165