Healthcare Provider Details

I. General information

NPI: 1316623747
Provider Name (Legal Business Name): CAROLYN TRAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL TRAN OD

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 MANHATTAN BLVD STE E2B
HARVEY LA
70058-3375
US

IV. Provider business mailing address

545 S JAMIE BLVD
AVONDALE LA
70094-2909
US

V. Phone/Fax

Practice location:
  • Phone: 504-309-8619
  • Fax:
Mailing address:
  • Phone: 504-575-1877
  • 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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2000-946AT
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: