Healthcare Provider Details

I. General information

NPI: 1255587291
Provider Name (Legal Business Name): NGUYEN T TRAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 09/30/2020
Certification Date: 09/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1844 SAN MIGUEL DR STE 300C
WALNUT CREEK CA
94596-4962
US

IV. Provider business mailing address

1844 SAN MIGUEL DR STE 300C
WALNUT CREEK CA
94596-4962
US

V. Phone/Fax

Practice location:
  • Phone: 916-719-0615
  • Fax:
Mailing address:
  • Phone: 510-693-8053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14821
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number56007317
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number14821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: