Provider Demographics
NPI:1114082344
Name:TRAN, JOHAN M (PHD, OD)
Entity Type:Individual
Prefix:DR
First Name:JOHAN
Middle Name:M
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHD, OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8907 WARNER AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5080
Mailing Address - Country:US
Mailing Address - Phone:714-962-6400
Mailing Address - Fax:714-596-5972
Practice Address - Street 1:8907 WARNER AVE STE 125
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5080
Practice Address - Country:US
Practice Address - Phone:714-962-6400
Practice Address - Fax:714-596-5972
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11584T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH09Y003205NH02OtherANTHEM BLUE CROSS
NH7839223OtherCIGNA
930309OtherLUXOTTICA,EYEMED
930309OtherLUXOTTICA,EYEMED