MEDICARE: DR. TAN 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	15134TLG	CA

General Provider Information

NPI Number	:	1568844470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAN TRAN O.D.

Provider Business Mailing Address
First Line	:	11751 RANCHITO ST
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-1317
Country	:	US
Telephone Number	:	626-872-8740
Fax Number	:

Provider Business Practice Location Address
First Line	:	12471 LIMONITE AVE
Second Line	:
City	:	EASTVALE
State	:	CA
Zip	:	91752-2457
Country	:	US
Telephone Number	:	626-872-8740
Fax Number	:

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

Provider Enumeration Date	:	06/26/2015
Last Update Date	:	08/13/2015

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