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General NPI Number Information
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NPI Number | 1265441455
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Entity Type | Individual
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Provider Name | ANDREW VU THANH TRAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 112 E DIXIE AVE
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City | LEESBURG
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State | FL
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Zip | 34748-6350
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Country | US
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Telephone | 352-787-1956
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Fax | 352-365-6690
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Provider Business Mailing Address
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Address Line | 4137 BRIAR GATE LN
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City | WINTER GARDEN
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State | FL
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Zip | 34787-5521
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Country | US
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Telephone | 407-256-3763
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Fax |
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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 | OPC 004108
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License Number State | FL
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