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General NPI Number Information
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NPI Number | 1215088356
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Entity Type | Individual
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Provider Name | CLINT QUY TRAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 5707 CHRISTIE AVE POWELL STREET PLAZA
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City | EMERYVILLE
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State | CA
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Zip | 94608-2412
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Country | US
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Telephone | 510-547-8301
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Fax | 510-547-3739
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Provider Business Mailing Address
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Address Line | 2540 COLLEGE AVE #210
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City | BERKELEY
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State | CA
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Zip | 94704-3085
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Country | US
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Telephone | 510-887-1887
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Fax | 510-887-2812
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12689T
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License Number State | CA
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