Provider Demographics
NPI:1194203398
Name:PENN TRAN OD, INC
Entity Type:Organization
Organization Name:PENN TRAN OD, INC
Other - Org Name:EYE-C-YOU OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PENN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-248-0088
Mailing Address - Street 1:1299 UNIVERSITY AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7236
Mailing Address - Country:US
Mailing Address - Phone:951-248-0088
Mailing Address - Fax:951-248-0099
Practice Address - Street 1:1299 UNIVERSITY AVE STE 103
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-7236
Practice Address - Country:US
Practice Address - Phone:951-248-0088
Practice Address - Fax:951-248-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12521T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty