Provider Demographics
NPI:1346355401
Name:TRAN, KATHY (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
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 1:200 MINOR HL
Mailing Address - Street 2:UC BERKELEY SCHOOL OF OPTOMETRY
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-2020
Mailing Address - Country:US
Mailing Address - Phone:510-642-2020
Mailing Address - Fax:510-643-3796
Practice Address - Street 1:200 MINOR HL
Practice Address - Street 2:UC BERKELEY SCHOOL OF OPTOMETRY
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-2020
Practice Address - Country:US
Practice Address - Phone:510-642-2020
Practice Address - Fax:510-643-3796
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12865152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT 12865OtherBOARD OF OPTO. LICENSE