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General NPI Number Information
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NPI Number | 1407817265
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Entity Type | Individual
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Provider Name | TRANG D PHAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 31573 RANCHO PUEBLO RD STE 101
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City | TEMECULA
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State | CA
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Zip | 92592-4854
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Country | US
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Telephone | 951-302-5580
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Fax | 951-302-5581
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Provider Business Mailing Address
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Address Line | 518 WEST AVE
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City | TALLMADGE
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State | OH
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Zip | 44278-2117
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Country | US
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Telephone | 330-630-9699
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Fax | 330-630-3206
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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 | 5488
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 21354-875
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License Number State | WI
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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 | 34912TLG
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License Number State | CA
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