Provider Demographics
NPI:1215142211
Name:KLEMENS, SUSAN TRAN (OD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:TRAN
Last Name:KLEMENS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:THI
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:23502 ENCHANTED PATH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-4337
Mailing Address - Country:US
Mailing Address - Phone:510-274-9985
Mailing Address - Fax:
Practice Address - Street 1:410 VALLEY HI DR STE 204
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-4612
Practice Address - Country:US
Practice Address - Phone:210-969-4080
Practice Address - Fax:210-969-4010
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7961T152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist