Provider Demographics
NPI:1699278630
Name:TRAN, THERESA T (OD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:T
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7407 N WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64158-1246
Mailing Address - Country:US
Mailing Address - Phone:816-812-1773
Mailing Address - Fax:
Practice Address - Street 1:7250 CARSON BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2358
Practice Address - Country:US
Practice Address - Phone:562-377-0941
Practice Address - Fax:562-420-6459
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33900TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist