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General NPI Number Information
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NPI Number | 1275949752
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Entity Type | Organization
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Legal Business Name | DAVID RILEY TRAN OD LLC
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 4521 CAMEL ST
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City | METAIRIE
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State | LA
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Zip | 70001-4616
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Country | US
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Telephone | 814-244-5954
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Fax |
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Provider Business Mailing Address
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Address Line | 4521 CAMEL ST
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City | METAIRIE
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State | LA
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Zip | 70001-4616
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Country | US
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Telephone | 814-244-5954
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DAVID RILEY TRAN
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Credential | O.D.
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Telephone | 814-244-5954
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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 | 1418-542T
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License Number State | LA
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