Provider Demographics
NPI:1073582771
Name:KRISTIE TRANG OPTOMETRY, INC.
Entity Type:Organization
Organization Name:KRISTIE TRANG OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:MY
Authorized Official - Last Name:TRANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-791-2526
Mailing Address - Street 1:9260 SIERRA COLLEGE BLVD
Mailing Address - Street 2:SUITE #500
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5927
Mailing Address - Country:US
Mailing Address - Phone:916-791-2526
Mailing Address - Fax:916-791-2561
Practice Address - Street 1:9260 SIERRA COLLEGE BLVD
Practice Address - Street 2:SUITE #500
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5927
Practice Address - Country:US
Practice Address - Phone:916-791-2526
Practice Address - Fax:916-791-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1079152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31135ZMedicare ID - Type Unspecified