Provider Demographics
NPI:1053578336
Name:DR. TRAN OD PROFESSIONAL CORP
Entity type:Organization
Organization Name:DR. TRAN OD PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-942-6301
Mailing Address - Street 1:8826 S EASTERN AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-4826
Mailing Address - Country:US
Mailing Address - Phone:702-942-6301
Mailing Address - Fax:702-942-6303
Practice Address - Street 1:8826 S EASTERN AVE STE 112
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-4826
Practice Address - Country:US
Practice Address - Phone:702-942-6301
Practice Address - Fax:702-942-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002502042Medicaid
NV39026Medicare PIN
NV002502042Medicaid