MEDICARE: TRAINOR & NGAN PROFESSIONAL OPTOMETRIC CORPORATION

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ05960Z	OTHER	CA	GROUP PTAN

General Provider Information

NPI Number	:	1770557019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAINOR & NGAN PROFESSIONAL OPTOMETRIC CORPORATION

Provider Business Mailing Address
First Line	:	1172 LINCOLN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125
Country	:	US
Telephone Number	:	408-283-7100
Fax Number	:	408-283-7103

Provider Business Practice Location Address
First Line	:	1172 LINCOLN AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95125
Country	:	US
Telephone Number	:	408-283-7100
Fax Number	:	408-283-7103

Authorized Official
Title or Position	:	CO OWNER
Name	:	DR. JULIE G NGAN
Credential	:	OD
Telephone Number	:	408-283-7100

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	03/11/2019

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