Provider Demographics
NPI:1427621168
Name:TRAN, CAROLINE NGOC QUYNH (OD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:NGOC QUYNH
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4065 OCEANSIDE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5824
Mailing Address - Country:US
Mailing Address - Phone:760-945-2020
Mailing Address - Fax:760-945-3451
Practice Address - Street 1:4065 OCEANSIDE BLVD STE C
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5824
Practice Address - Country:US
Practice Address - Phone:760-945-2020
Practice Address - Fax:760-945-3451
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA34963152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program