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NPI Code Detail

MEDICARE: THU TRAN O.D

MEDICARE: THU 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
1152W00000XOptometrist33409CA

General Provider Information

NPI Number : 1598115602
Entity Type Code : Individual
Provider Name (Legal Business Name) : THU TRAN O.D
Provider Business Mailing Address
First Line : 7155 BROADWAY
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-1408
Country : US
Telephone Number : 619-315-0192
Fax Number :
Provider Business Practice Location Address
First Line : 7155 BROADWAY
Second Line :
City : LEMON GROVE
State : CA
Zip : 91945-1408
Country : US
Telephone Number : 619-315-0192
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2016
Last Update Date : 06/20/2016

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