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General NPI Number Information
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NPI Number | 1194203398
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Entity Type | Organization
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Legal Business Name | PENN TRAN OD, INC
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Dates
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Enumeration Date | 07/31/2018
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 1299 UNIVERSITY AVE STE 103
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City | RIVERSIDE
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State | CA
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Zip | 92507-7236
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Country | US
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Telephone | 951-248-0088
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Fax | 951-248-0099
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Provider Business Mailing Address
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Address Line | 1299 UNIVERSITY AVE STE 103
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City | RIVERSIDE
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State | CA
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Zip | 92507-7236
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Country | US
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Telephone | 951-248-0088
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Fax | 951-248-0099
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Authorized Official
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Title or Position | PRESIDENT
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Name | PENN TRAN
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Credential | OD
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Telephone | 951-248-0088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 12521T
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License Number State | CA
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