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General NPI Number Information
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NPI Number | 1528636198
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Entity Type | Individual
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Provider Name | RAPHAELLA TRAN OD, MS
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Gender | Female
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Dates
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Enumeration Date | 06/11/2021
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 360 S WAUKEGAN RD STE A
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City | DEERFIELD
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State | IL
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Zip | 60015-5654
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Country | US
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Telephone | 847-412-0311
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Fax | 847-412-0316
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Provider Business Mailing Address
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Address Line | 111 E 4TH ST STE 440
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City | ALTON
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State | IL
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Zip | 62002-6241
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Country | US
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Telephone | 618-462-9818
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Fax | 314-741-4947
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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 | 046.011529
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License Number State | IL
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