Healthcare Provider Details

I. General information

NPI: 1245166206
Provider Name (Legal Business Name): COURTNEY TRAN OD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 COURT ST
BROOKLYN NY
11201-5608
US

IV. Provider business mailing address

121 COURT ST
BROOKLYN NY
11201-5608
US

V. Phone/Fax

Practice location:
  • Phone: 718-858-7036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011415
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: