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General NPI Number Information
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NPI Number | 1356837546
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Entity Type | Organization
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Legal Business Name | THAI TRAN OPTOMETRY CORPORATION
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Dates
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Enumeration Date | 07/10/2018
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 1500 ADAMS AVE STE 102
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City | COSTA MESA
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State | CA
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Zip | 92626
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Country | US
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Telephone | 714-200-3629
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 ADAMS AVE STE 102
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City | COSTA MESA
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State | CA
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Zip | 92626-3864
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THAI TRAN
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Credential | O.D.
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Telephone | 714-617-5030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 14289TLG
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 14289TLG
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14289TLG
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License Number State | CA
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