Provider Demographics
NPI:1932395761
Name:TRAN, SIMON T (OD)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:T
Last Name:TRAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:12401 JEFFERSON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4311
Mailing Address - Country:US
Mailing Address - Phone:757-877-0388
Mailing Address - Fax:757-833-7229
Practice Address - Street 1:12401 JEFFERSON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4311
Practice Address - Country:US
Practice Address - Phone:757-877-0388
Practice Address - Fax:757-833-7229
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2011-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001714152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist