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General NPI Number Information
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NPI Number | 1639509789
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Entity Type | Organization
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Legal Business Name | THAO NGUYEN TRAN MD SC
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Dates
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Enumeration Date | 11/26/2013
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 7201 GREEN BAY RD STE C
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City | KENOSHA
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State | WI
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Zip | 53142-3532
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Country | US
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Telephone | 262-842-2358
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Fax | 888-959-8367
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Provider Business Mailing Address
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Address Line | 7201 GREEN BAY, SUITE C
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City | KENOSHA
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State | WI
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Zip | 53142-3532
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Country | US
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Telephone | 262-842-2358
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Fax | 888-959-8367
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Authorized Official
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Title or Position | PHYSICIAN
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Name | THAO NGUYEN TRAN
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Credential |
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Telephone | 262-842-2358
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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