=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730754714
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. TRAM TON-TRAN OD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2021
-----------------------------------------------------
Last Update Date | 05/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 903 W CENTER ST STE 9
-----------------------------------------------------
City | MANTECA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95337-7315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-823-1727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 903 W CENTER ST STE 9
-----------------------------------------------------
City | MANTECA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95337-7315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-823-1727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TRAM TON-TRAN
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 209-823-1727
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------