Provider Demographics
NPI:1992774699
Name:TRANG, KRISTIE MY (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:MY
Last Name:TRANG
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1422 BLUE OAKS BLVD
Mailing Address - Street 2:SUITE #150
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-5196
Mailing Address - Country:US
Mailing Address - Phone:916-783-3937
Mailing Address - Fax:916-783-3935
Practice Address - Street 1:1422 BLUE OAKS BLVD
Practice Address - Street 2:SUITE #150
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-5196
Practice Address - Country:US
Practice Address - Phone:916-783-3937
Practice Address - Fax:916-783-3935
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2013-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA11441152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0114410Medicare UPIN