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General NPI Number Information
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NPI Number | 1417619669
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Entity Type | Individual
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Provider Name | CRYSTAL TRAN OD
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Gender | Female
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 7447 N FIGUEROA ST STE 200
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City | LOS ANGELES
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State | CA
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Zip | 90041-1721
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Country | US
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Telephone | 323-257-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 2233 CALLE LISETA
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City | SAN DIMAS
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State | CA
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Zip | 91773-3942
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Country | US
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Telephone | 626-617-2048
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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 | 35024
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License Number State | CA
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