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General NPI Number Information
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NPI Number | 1962795849
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Entity Type | Organization
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Legal Business Name | TRANGDAI VUONG HOANG-TRAN, O.D., S.C.
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 12/03/2012
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Provider Practice Location Address
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Address Line | 7018-20 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60645-3416
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Country | US
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Telephone | 773-274-1880
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Fax | 773-274-1881
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Provider Business Mailing Address
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Address Line | 7018-20 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60645-3416
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Country | US
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Telephone | 773-274-1880
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Fax | 773-274-1881
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TRANGDAI VUONG HOANG-TRAN
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Credential | O.D.
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Telephone | 773-895-4799
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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 | 046010397
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License Number State | IL
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