Provider Demographics
NPI:1154435600
Name:TRAN, AGNES L (OD)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:L
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 W UNIVERSITY ST STE C
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1964
Mailing Address - Country:US
Mailing Address - Phone:417-831-8222
Mailing Address - Fax:877-417-7310
Practice Address - Street 1:520 W UNIVERSITY ST STE C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1964
Practice Address - Country:US
Practice Address - Phone:417-831-8222
Practice Address - Fax:877-417-7310
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000166242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist