MEDICARE: TRANG TAM TRAN 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	378	NV

General Provider Information

NPI Number	:	1083775258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRANG TAM TRAN O.D.

Provider Business Mailing Address
First Line	:	5222 SAN MILANO AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-0454
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 MARKS ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-6654
Country	:	US
Telephone Number	:	702-434-2441
Fax Number	:	702-434-6409

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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Directions to “ TRANG TAM TRAN O.D.” Practice Location

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