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General NPI Number Information
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NPI Number | 1477801827
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Entity Type | Individual
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Provider Name | JOHN NATHAN TRAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 08/31/2015
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Provider Practice Location Address
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Address Line | 1455 SEMORAN BLVD 275
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City | CASSELBERRY
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State | FL
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Zip | 32707-6522
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Country | US
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Telephone | 407-960-2689
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Fax |
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Provider Business Mailing Address
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Address Line | 1455 SEMORAN BLVD 275
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City | CASSELBERRY
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State | FL
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Zip | 32707-6522
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Country | US
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Telephone | 407-960-2689
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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 | OPC4729
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License Number State | FL
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