Provider Demographics
NPI:1083692735
Name:TRAN, ANH M (OD)
Entity Type:Individual
Prefix:DR
First Name:ANH
Middle Name:M
Last Name:TRAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 N WOODLAWN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3947
Mailing Address - Country:US
Mailing Address - Phone:316-686-6063
Mailing Address - Fax:316-686-4214
Practice Address - Street 1:2251 N WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3947
Practice Address - Country:US
Practice Address - Phone:316-686-6063
Practice Address - Fax:316-686-4214
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1540-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS269152OtherCOVENTRY-LOC#1
KS463315Medicaid
KS100330040AMedicaid
KS10898OtherPPK
KS265105OtherCOVENTRY-LOC#2
KS053916Medicare PIN
KS265105OtherCOVENTRY-LOC#2
KS100330040AMedicaid
KSP00391078Medicare PIN
KS053915Medicare PIN