MEDICARE: DR. LIEN TRAN GRIFFIN O.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	5860TG	TX

General Provider Information

NPI Number	:	1073554606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIEN TRAN GRIFFIN O.D

Provider Business Mailing Address
First Line	:	4950 OVERTON RIDGE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1909
Country	:	US
Telephone Number	:	817-294-3371
Fax Number	:	817-294-1534

Provider Business Practice Location Address
First Line	:	4950 OVERTON RIDGE BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1909
Country	:	US
Telephone Number	:	817-294-3371
Fax Number	:	817-294-1534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	11/22/2020

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