MEDICARE: DR. HAI MOC 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	0386	NV

General Provider Information

NPI Number	:	1427184555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAI MOC TRAN O.D.

Provider Business Mailing Address
First Line	:	623 CHERVIL VALLEY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-2003
Country	:	US
Telephone Number	:	702-795-8880
Fax Number	:	702-451-8887

Provider Business Practice Location Address
First Line	:	3200 LAS VEGAS BLVD S
Second Line	:	STE#1690
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2612
Country	:	US
Telephone Number	:	702-795-8880
Fax Number	:	702-451-8887

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

Provider Enumeration Date	:	02/25/2007
Last Update Date	:	07/08/2007

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