Provider Demographics
NPI:1265441455
Name:TRAN, ANDREW VU THANH (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:VU THANH
Last Name:TRAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 BRIAR GATE LN
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5521
Mailing Address - Country:US
Mailing Address - Phone:407-256-3763
Mailing Address - Fax:
Practice Address - Street 1:112 E DIXIE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6350
Practice Address - Country:US
Practice Address - Phone:352-787-1956
Practice Address - Fax:352-365-6690
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 004108152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621137200Medicaid
FLV10925Medicare UPIN
FLU8986ZMedicare PIN
FL621137200Medicaid
FLU8986YMedicare PIN