Provider Demographics
NPI:1215115522
Name:CHARLENE TRAN OPTOMETRY, INC
Entity type:Organization
Organization Name:CHARLENE TRAN OPTOMETRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-836-8251
Mailing Address - Street 1:8650 SAN YSIDRO AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-5267
Mailing Address - Country:US
Mailing Address - Phone:408-848-9922
Mailing Address - Fax:408-848-9944
Practice Address - Street 1:8650 SAN YSIDRO AVE.
Practice Address - Street 2:SUITE 104
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5268
Practice Address - Country:US
Practice Address - Phone:408-848-9922
Practice Address - Fax:408-848-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12966T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0129660ZMedicare PIN