Basic Information
| Provider Information | |||||||||
| NPI: | 1699278630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7407 N WALLACE AVE | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641581246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8168121773 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7250 CARSON BLVD | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908082358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5623770941 | ||||||||
| FaxNumber: | 5624206459 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2018 | ||||||||
| LastUpdateDate: | 03/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 33900TLG | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.