Provider Demographics
NPI:1063686749
Name:KEVIN TRAN & ASSOCIATES OPTOMETRIC CORP.
Entity Type:Organization
Organization Name:KEVIN TRAN & ASSOCIATES OPTOMETRIC CORP.
Other - Org Name:NUVISION OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-429-2991
Mailing Address - Street 1:7509 CARSON BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2365
Mailing Address - Country:US
Mailing Address - Phone:562-429-2991
Mailing Address - Fax:
Practice Address - Street 1:7509 CARSON BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2365
Practice Address - Country:US
Practice Address - Phone:562-429-2991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11455T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0114550Medicaid
CASD0114550Medicaid